Actualización terapéutica de la queratopatía bullosa pseudoafáquica / Therapeutic update on pseudophakic bullous keratopathy

RESUMEN La queratopatía bullosa pseudoafáquica o edema corneal crónico pseudoafáquico del paciente operado por cataratas con implante de lente intraocular es un proceso en el que la córnea se edematiza y pierde su función óptica, con síntomas dolorosos e irritativos de lagrimeo, ojo rojo, probabilidad de inflamación y ulceración corneal por infección secundaria. Se observan en esta afección multicausal dos grupos de pacientes. En uno de ellos el daño estructural corneal y ocular ha sido excesivo y no existe expectativa de mejora visual. El otro grupo aún conserva la potencialidad de recuperación de la agudeza visual. En el intento de solucionar esta afección se han empleado diversos tratamientos con fundamentos diferentes y resultados acordes con el desarrollo técnico y científico en que fueron aplicados. Es propósito de esta actualización describir y adecuar las posibilidades que los oftalmólogos puedan aplicar como terapéutica en sus respectivos niveles de actuación(AU)

ABSTRACT Pseudophakic bullous keratopathy or chronic pseudophakic corneal edema in patients undergoing cataract surgery with intraocular lens implantation is a process in which the cornea edematizes and loses optical function, with painful and irritating lacrimation symptoms, red eye, probable inflammation and corneal ulceration due to secondary infection. Sufferers of this multicausal condition are divided into two groups: In one of them structural corneal and ocular damage has been extreme and no visual improvement is expected, whereas in the other visual acuity recovery is still possible. In an attempt to heal this condition various treatments have been used with different rationales and results according to the scientific and technological development of the setting where they were applied. The present update is aimed at describing and adjusting the possible therapies that ophthalmologists may use in their respective fields of activity(AU)

Manual Preparation of Donor Lenticule Using Artificial Anterior Chamber for Descemet's Membrane Stripping Endothelial Keratoplasty

PURPOSE: To report a patient with a pseudophakic bullous keratopathy (PBK) who underwent Descemet's membrane stripping endothelial keratoplasty (DSEK) with manual preparation of the donor corneal graft.CASE SUMMARY: A 61-year-old female presented with visual disturbance in her right eye. Five months prior, she was treated with phacoemulsification and intraocular lens exchange surgery of the right eye, and a very severe corneal edema was revealed by slit-lamp examination. We diagnosed PBK and planned DSEK with manual preparation of a donor corneal graft because of the non-availability of a microkeratome or a femtosecond laser. After making the corneal graft using an artificial anterior chamber, crescent knife and cornea dissector, the keratoplasty proceeded using the graft. Three months after surgery, her graft was well-maintained on the right eye. The patient's visual acuity was 0.3, and the corneal endothelial cell count was 1,844/mm².CONCLUSIONS: Manual preparation of the donor corneal graft for DSEK is suitable as a second choice treatment method when the availability of surgical devices is limited.

Clinical Outcomes of Combined Descemet-stripping Endothelial Keratoplasty and Intraocular Lens Exchange

PURPOSE: To evaluate clinical outcomes after combined descemet-stripping endothelial keratoplasty (DSEK) and intraocular lens (IOL) exchange in a Korean population. METHODS: The medical records of 15 patients (15 eyes) with pseudophakic bullous keratopathy who underwent combined DSEK and IOL exchange from January 2011 to January 2015 and who were followed up for more than 12 months were reviewed retrospectively. RESULTS: In 14 eyes with successful results after surgery, the best corrective visual acuity (BCVA) was significantly improved from 2.01 ± 0.96 (log MAR, mean) to 0.68 ± 0.26 at 3 months (p = 0.001) except for one eye that received reoperation on the endothelial disc detachment. The BCVA at postoperative 6 and 12 months gradually increased (0.51 ± 0.26 and 0.40 ± 0.22 log MAR, mean). Central corneal thickness was significantly improved from 777 ± 139 µm to 605 ± 28 µm at 6 months (p = 0.003) and was maintained at 12 months. The mean endothelial cell count was 2,973 ± 281/mm2 in the donor lenticules and 1,790 ± 265/mm2 at 12 months. Endothelial cell loss was 40%. The target refraction was -0.81 ± 0.16 D and the 12 months postoperative spherical equivalent was -0.28 ± 0.36 D. Complications included intraocular pressure elevation in one eye and pupillary capture in one eye. CONCLUSIONS: Combined DSEK and IOL exchange may be a very efficient and safe option for surgically managing pseudophakic bullous keratopathy.

Clinical Effects of Phototherapeutic Keratectomy on Terminal Bullous Keratopathy

PURPOSE: Although the treatment of choice for bullous keratopathy is typically penetrating keratoplasty (PKP), not all patients are suited for this treatment. Thus, we evaluated the clinical effects of phototherapeutic keratectomy (PTK) on pain relief and on the improvement of photophobia and visual acuity in patients suffering from bullous keratopathy. METHODS: Twenty-three patients with bullous keratopathy who were awaiting PKP and suffering from ocular pain, photophobia, and cosmetic problems, were assessed. Twelve eyes were treated with PTK using the excimer laser (VISX STAR S3, Irvine, CA, U.S.A). Another 11 eyes were treated with eye drops or other conservative modalities. Statistically significant differences in pain relief, photophobia improvement, and cosmetic improvement between two groups were assessed by Fisher's exact test. RESULTS: Twelve eyes with bullous keratopathy underwent PTK. At post-operative 1 month, 83% of patients showed relief of pain, 75% of patients showed improvements in photophobia, and 58% of patients had increased visual acuity of one or more line. The overall satisfaction rate of PTK was 91%, but 67% of patients showed recurrence of corneal opacity and bullae formation at 6 months after the procedure. CONCLUSIONS: Phototherapeutic keratectomy (PTK) reduced pain and improved visual acuity slightly in patients with bullous keratopathy. This procedure could be considered a valuable alternative treatment modality while awaitng PKP.