Spontaneous corneal clearing after Descemet's stripping without endothelial replacement

Abstract

Purpose: To report spontaneous corneal clearing with improved visual acuity and central endothelial cell repopulation after Descemet's stripping without endothelial replacement.

Design: Interventional case report.

Methods: A 34-year-old woman with bilateral decreased vision secondary to corneal edema from endothelial dysfunction underwent Descemet's stripping endothelial keratoplasty (DSEK) in the right eye and Descemet's stripping only in the left eye. Histopathologic evaluation confirmed a dual diagnosis of Fuchs' endothelial dystrophy and posterior polymorphous membrane dystrophy from Descemet's membrane specimens removed from each eye. After primary graft failure with regraft in the right eye, the second posterior corneal lenticule detached and was removed and not replaced. The cornea cleared, and central endothelial cell repopulation was documented by confocal microscopy. Therefore, Descemet's stripping without endothelial replacement was performed in the left eye. The left cornea also cleared with central endothelial cell repopulation.

Main outcome measures: Postoperative visual acuity and central endothelial cell repopulation.

Results: Endothelial migration after Descemet's stripping alone in the left eye, with probable host endothelial cell repopulation in the right eye.

Conclusions: Endothelial cell migration after Descemet's stripping procedure without insertion of endothelial graft can occur, resulting from host endothelial cell repopulation with corneal clearing and improved visual acuity.

Conflict of interest statement

The Authors have no financial interests in the products or topics in this manuscript

Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Slit lamp photo of right cornea demonstrating a beaten metal appearance of the endothelium notable in slit view (Left image) and in retroillumination (Right image).

Figure 2

Confocal imaging of the right cornea demonstrating an irregular endothelial mosaic pattern with patchy alternating hypo and hyper-reflective regions in an inconsistent pattern.

Figure 3

Descemet’s membrane is thickened and contains posterior nodular excrescences with thickened Descemet’s membrane (Top image) with multilayered, scattered endothelial cells positive for cytokeratins AE1,3 and MAK 6 immunohistochemical satins (Bottom image). (Periodic acid schiff, 100X)

Figure 4

Slit lamp photo of right and left corneas during the healing process after surgery. The right cornea (left image) shows peripheral graft detachment with corneal clearing in the detached section (superiorly in the image) as compared to the persistent central edema in the central regions of graft adherence, while the left cornea (right image) shows similar peripheral corneal clearing with residual central edema after the Descemet’s stripping only procedure.

Figure 5

Confocal imaging showing presence of new endothelial cells in the superior cornea of right eye with persistent central edema and haze.

Figure 6

Slit lamp photo of right and left cornea at final evaluation. The right cornea cornea (left image) shows complete resolution of corneal edema with corneal clarity, while the left cornea (right image) shows resolution of central corneal edema with deep paracentral stromal haze in the region corresponding to final endothelial cell repopulation.

Figure 7

Confocal imaging of right cornea showing repopulation of endothelial cells throughout the central cornea.

Figure 8

Confocal imaging of left cornea showing repopulation of endothelial cells throughout the central cornea.