ABSTRACT
Poor visual function associated with Fuchs endothelial corneal dystrophy (FECD) is one of the main indications for keratoplasty. Reports of successful visual rehabilitation of patients with spontaneous or scheduled removal of the Descemet's membrane and the endothelium or donor material adhesion failure, suggest this research direction perspective. AIM: to evaluate the potential as well as clinical and functional outcomes of phacoemulsification with central circular descemetorhexis in patients with Fuchs endothelial corneal dystrophy. MATERIAL AND METHODS: A total of 19 patients aged 51-84 years were included. The preoperative best corrected visual acuity averaged 0.32±0.19, endothelial cells density - 629.6±336.9 cells/mm2, and central corneal pachymetry - 587.8±44.8 µm. After phacoemulsification with IOL implantation, a 4 mm tap was created from the epithelial side of the cornea. Central circular descemetorhexis was done using a microhook. The membrane was removed with microforceps. RESULTS: On day 1, there was central corneal edema matching the circular defect in the Descemet's membrane. As many as 26.3% of patients demonstrated rapid responses to the treatment, which implies that corneal transparency and visual improvement were achieved by the end of the first month after surgery. In other 26.3% of patients, full corneal transparency was not achieved and, therefore, endothelium transplantation had to be performed. The main group included 12 patients. At 12 months, the best corrected visual acuity was 0.66±0.29, central pachymetry - 569.27±63.74 µm, endothelial cells density - 634.00±170.41 cells/mm2. CONCLUSION: In 63.8% of patients, visual rehabilitation was achieved without endothelial transplantation, which provides new prospects for tissue-saving technologies in patients with endothelial corneal dystrophy.
Subject(s)
Cataract/diagnosis , Descemet Stripping Endothelial Keratoplasty , Fuchs' Endothelial Dystrophy , Lens Implantation, Intraocular/methods , Phacoemulsification , Aged , Corneal Pachymetry/methods , Descemet Membrane/surgery , Descemet Stripping Endothelial Keratoplasty/methods , Descemet Stripping Endothelial Keratoplasty/rehabilitation , Endothelium, Corneal/surgery , Female , Fuchs' Endothelial Dystrophy/diagnosis , Fuchs' Endothelial Dystrophy/surgery , Humans , Male , Middle Aged , Ophthalmoscopy/methods , Outcome and Process Assessment, Health Care , Phacoemulsification/methods , Phacoemulsification/rehabilitation , Russia , Visual AcuityABSTRACT
The diversity of methodological approaches and lack of pathogenetically reasonable tactics for patients with combined ocular injuries became the basis for the development and systematization of surgical rehabilitation stages of patients, in whom post-traumatic cataract is combined with post-traumatic aniridia and corneal scarring. AIM: to construct a visual rehabilitation approach to patients with post-traumatic defects of the anterior eye segment following optical-reconstructive surgery that involved implantation of an iris-lens diaphragm (ILD). MATERIAL AND METHODS: We have analyzed 80 reconstructive cases with ILD implantation in patients with post-traumatic aniridia and corneal damage. These patients constituted the first study group (Group 1). We have also investigated 58 eyes with residual ametropy and stable visual function 1 year after ILD implantation before and after conducting a laser keratorefractive surgery. These patients were assigned to the second study group (Group 2). RESULTS: Rehabilitation approach to patients after anterior segment injuries that has been proposed allows to achieve high clinical and functional results and reduce the risk of intra- and postoperative complications. CONCLUSION: The proposed approach to patients after optical-reconstructive surgery with iris-lens diaphragm implantation followed by keratorefractive surgery is an effective method of visual rehabilitation of anterior eye segment post-traumatic defects.
