FEB 05, 2015
This small case series found that not using a donor graft after Descmet stripping can impede endothelial cell repopulation and lead to worse visual outcomes.
The authors reviewed the charts of three patients with Fuchs’ endothelial dystrophy, aged 40 to 46 years, who underwent removal of the central Descemet membrane without concomitant endothelial keratoplasty.
In each case, endothelial cells repopulated the majority of the descemetorhexis area within about four months. However, zones where posterior stroma had been roughened during the descemetorhexis resulted in areas of persistent focal edema and associated chronic corneal changes.
In one case, persistent edema and scarring led to an irregular ocular surface requiring a scleral contact lens to improve visual acuity. A second case had a similar result with residual irregular astigmatism. In a third case, by year one postoperatively, the uncorrected visual acuity had declined from 20/25 to 20/60 with increasing stromal thickness in the zone of persistent edema/roughened posterior stroma ultimately requiring DMEK.
Given the postoperative complications seen in this small case series, the authors do not recommend this type of Descemet stripping without graft placement until there are better ways to stimulate and control endothelial cell repopulation.