ABSTRACT
BACKGROUND/AIMS: To determine whether the stromal rim that carries the bare endothelial graft in Descemet's membrane automated endothelial keratoplasty (DMAEK) has any effect on final visual outcome or visual quality. METHODS: Twenty-four DMAEK eyes and 22 Descemet's membrane endothelial keratoplasty (DMEK) eyes (with no stromal rim) were evaluated for corrected distance acuity, full-field Humphrey visual field (VF) 120-2 and pupil size. The inner and outer diameter of the DMAEK stromal ring was measured from slit lamp photos. Patients completed a questionnaire rating postoperative symptoms and visual complaints. Exclusion criteria were pre-existing glaucoma, retinal pathology or inability to return for postoperative examinations. RESULTS: Median Snellen acuities were comparable between DMAEK and DMEK groups: 20/25 and 20/20-3, respectively. The mean central opening of the DMAEK stromal ring was 5.6 × 5.5 (range 3.8-6.9) mm. The incidence of VF defects, visual complaints of glare, halos, light sensitivity and night driving difficulties was comparable between groups (all p > 0.1). A larger scotopic pupil size (< 5.5 mm) was not associated with increased incidence of VF defects in either group (p = 0.3). CONCLUSIONS: Surprisingly, compared with uniformly thin DMEK grafts, DMAEK grafts with a stromal rim had no increase in VF defects or visual complaints.
Subject(s)
Descemet Membrane/surgery , Endothelium, Corneal/surgery , Keratoplasty, Penetrating/methods , Refraction, Ocular/physiology , Visual Acuity/physiology , Aged , Descemet Membrane/physiopathology , Endothelium, Corneal/physiopathology , Endothelium, Corneal/transplantation , Female , Humans , Male , Middle Aged , Prospective Studies , Tomography, Optical Coherence , Treatment OutcomeABSTRACT
PURPOSE: We report the occurrence and outcome of a severe late-onset traumatic dislocation of a laser in situ keratomileusis (LASIK) flap with loss of central flap tissue. METHODS: Case report. RESULTS: A 40-year-old woman underwent uncomplicated bilateral LASIK surgery, followed 5 years later by an enhancement procedure in both eyes. Ocular trauma with a power sander occurred 6 years after LASIK and 1 year after the enhancement procedure. The flap was found to have an almost complete tear from the nasal hinge and a central tissue defect. After irrigating, repositioning, and stabilizing the flap with 2 nylon sutures, a bandage contact lens was placed. The patient was treated with topical antibiotic and steroid drops. Stage 2 diffuse lamellar keratitis developed, which responded to topical treatment. Ten weeks after injury, the patient regained an uncorrected visual acuity of 20/20-1. CONCLUSION: Late-onset trauma to the LASIK flap can result in flap dehiscence and tissue loss. Prompt and appropriate management can lead to an excellent visual outcome even in severely traumatized dislocated LASIK flaps.
