Advertisement

Descemet stripping only in Fuchs’ endothelial dystrophy without use of topical Rho-kinase inhibitors: 5-year follow-up

      Abstract

      Objective

      To describe 5-year postoperative outcomes of a small series of Fuchs’ endothelial dystrophy (FED) patients who underwent Descemet stripping only (DSO) with a scraping technique.

      Methods

      DSO technique and early clinical outcomes of 5 patients with mild central FED were previously reported. In the same cohort of patients, corrected distance visual acuity, central corneal ultrasound pachymetry, refractive spherical equivalent, endothelial cell count, slit-lamp photography, and corneal Scheimpflug tomography were obtained at baseline, 6 months, and 1 and 5 years postoperatively. No patient used topical Rho-kinase inhibitors at any point in time.

      Results

      One patient (20%) failed to clear the early postoperative edema and 1 patient (20%) developed corneal decompensation 1 year after DSO. Both patients underwent successful Descemet stripping automated endothelial keratoplasty. The remaining 3 patients had stable corrected distance visual acuity, progressive reduction of corneal ultrasound pachymetry, and mild myopic shift of the refractive spherical equivalent over the follow-up time. An improvement in posterior stromal opacities and irregular astigmatism was observed, whereas posterior elevation at Scheimpflug tomography remained unchanged.

      Conclusion

      At 5 years postoperatively, DSO with a scraping technique and without Rho-kinase inhibitors resulted in sustained clinical amelioration of 3 of 5 patients (60%) with mild FED.

      Objectif

      Décrire l’évolution postopératoire à 5 ans d'une petite série de patients qui présentaient une dystrophie endothéliale de Fuchs (FED) et qui ont subi un descemetorhexis seul (DSO) par l'entremise d'une technique de grattage.

      Méthodes

      On avait déjà présenté la technique du DSO et les résultats cliniques précoces de l'intervention réalisée chez 5 patients en raison d'une légère FED centrale. On a mesuré, chez ces mêmes patients, les paramètres suivants au départ, ainsi que 6 mois, 1 an et 5 ans après l'intervention : acuité visuelle corrigée de loin, pachymétrie cornéenne centrale par échographie, équivalent sphérique de réfraction, numération des cellules endothéliales, photographie à la lampe à fente et examen de la cornée à la tomographie de Scheimpflug. Aucun patient n'a reçu de collyre à base d'inhibiteurs de la rho-kinase.

      Résultats

      Un seul sujet (20 %) n'a pas bénéficié d'une disparition complète de l’œdème peu de temps après l'intervention; de même, 1 seul patient (20 %) a présenté une décompensation cornéenne 1 an après le DSO. Les 2 patients ont subi, avec succès, une kératoplastie endothéliale automatisée de la membrane de Descemet. On a enregistré, chez les 3 autres patients, une acuité visuelle corrigée de loin stable, une réduction progressive des mesures de la pachymétrie cornéenne par échographie ainsi qu'un léger écart myopique de l’équivalent sphérique de réfraction pendant le suivi. Une amélioration des opacités stromales postérieures et un astigmatisme irrégulier ont été observés; par contre, il ne s'est produit aucun changement quant à l’élévation postérieure lors de la tomographie de Scheimpflug.

      Conclusion

      Cinq ans après le DSO s'accompagnant d'une technique de grattage et en l'absence d'inhibiteurs de la rho-kinase, on note une amélioration clinique persistante chez 3 des 5 patients (60 %) qui présentaient une FED légère.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kaufman AR
        • Nosé RM
        • Pineda R.
        Descemetorhexis without endothelial keratoplasty (DWEK): proposal for nomenclature standardization.
        Cornea. 2018; 37: e20-e21
        • Moloney G
        • Iovieno A
        • Colby KA
        Reply.
        Cornea. 2018; 37: e21-e22
        • Iovieno A
        • Neri A
        • Soldani AM
        • Adani C
        • Fontana L.
        Descemetorhexis without graft placement for the treatment of Fuchs’ endothelial dystrophy: preliminary results and review of the literature.
        Cornea. 2017; 36: 637-641
        • Borkar DS
        • Veldman P
        • Colby KA.
        Treatment of Fuchs’ endothelial dystrophy by Descemet stripping without endothelial keratoplasty.
        Cornea. 2016; 35: 1267-1273
        • Moloney G
        • Petsoglou C
        • Ball M
        • et al.
        Descemetorhexis without grafting for Fuchs’ endothelial dystrophy: supplementation with topical ripasudil.
        Cornea. 2017; 36: 642-648
        • Moloney G
        • Chan UT
        • Hamilton A
        • Zahidin AM
        • Grigg JR
        • Devasahayam RN.
        Descemetorhexis for Fuchs’ dystrophy.
        Can J Ophthalmol. 2015; 50: 68-72
        • Moloney G
        • Garcerant Congote D
        • Hirnschall N
        • et al.
        Descemet stripping only supplemented with topical ripasudil for Fuchs’ endothelial dystrophy :12-month outcomes of the Sydney Eye Hospital study.
        Cornea. 2021; 40: 320-326
        • Macsai MS
        • Shiloach M.
        Use of topical Rho kinase inhibitors in the treatment of Fuchs’ dystrophy after Descemet stripping only.
        Cornea. 2019; 38: 529-534
        • Huang MJ
        • Kane S
        • Dhaliwal DK.
        Descemetorhexis without endothelial keratoplasty versus DMEK for treatment of Fuchs’ endothelial corneal dystrophy.
        Cornea. 2018; 37: 1479-1483
        • Artaechevarria Artieda J
        • Wells M
        • Devasahayam RN
        • Moloney G
        5-Year outcomes of Descemet stripping only in Fuchs’ dystrophy.
        Cornea. 2020; 39: 1048-1051
        • Rao R
        • Borkar DS
        • Colby KA
        • Veldman PB.
        Descemet membrane endothelial keratoplasty after failed Descemet stripping without endothelial keratoplasty.
        Cornea. 2017; 36: 763-766
        • Birbal RS
        • Parker J
        • Dirisamer M
        • et al.
        Descemet membrane endothelial transfer: ultimate outcome.
        Cornea. 2018; 37: 141-144
        • Kinoshita S
        • Colby KA
        • Kruse FE
        A close look at the clinical efficacy of Rho-associated kinase inhibitor eye drops for Fuchs’ endothelial corneal dystrophy.
        Cornea. 2021; : 1-4
        • Okumura N
        • Okazaki Y
        • Inoue R
        • et al.
        Rho-associated kinase inhibitor eye drop (ripasudil) transiently alters the morphology of corneal endothelial cells.
        Invest Ophthalmol Vis Sci. 2015; 56: 7560-7567
        • Okumura N
        • Okazaki Y
        • Inoue R
        • et al.
        Effect of the rho-associated kinase inhibitor eye drop (ripasudil) on corneal endothelial wound healing.
        Invest Ophthalmol Vis Sci. 2016; 57: 1284-1292
        • Schlötzer-Schrehardt U
        • Zenkel M
        • Strunz M
        • et al.
        Potential functional restoration of corneal endothelial cells in Fuchs’ endothelial corneal dystrophy by ROCK inhibitor (ripasudil).
        Am J Ophthalmol. 2021; 224: 185-199
        • Okumura N
        • Kinoshita S
        • Koizumi N.
        Application of Rho kinase inhibitors for the treatment of corneal endothelial diseases.
        J Ophthalmol. 2017; 20172646904
        • Kinoshita S
        • Koizumi N
        • Ueno M
        • et al.
        Injection of cultured cells with a ROCK inhibitor for bullous keratopathy.
        N Engl J Med. 2018; 378: 995-1003
        • Koizumi N
        • Okumura N
        • Ueno M
        • Nakagawa H
        • Hamuro J
        • Kinoshita S.
        Rho-associated kinase inhibitor eye drop treatment as a possible medical treatment for Fuchs’ corneal dystrophy.
        Cornea. 2013; 32: 1167-1170
        • Ploysangam P
        • Patel SP.
        A case report illustrating the postoperative course of descemetorhexis without endothelial keratoplasty with topical netarsudil therapy.
        Case Rep Ophthalmol Med. 2019; 2019: 1-7
        • Garcerant D
        • Hirnschall N
        • Toalster N
        • Zhu M
        • Wen L
        • Moloney G.
        Descemet's stripping without endothelial keratoplasty.
        Curr Opin Ophthalmol. 2019; 30: 275-285
        • Davies E
        • Jurkunas U
        • Pineda R.
        Predictive factors for corneal clearance after descemetorhexis without endothelial keratoplasty.
        Cornea. 2018; 37: 137-140
        • Kassumeh S
        • von Studnitz A
        • Priglinger SG
        • et al.
        Ex vivo excimer laser ablation of cornea guttata and ROCK inhibitor-aided endothelial recolonization of ablated central cornea.
        Acta Ophthalmol. 2020; 98: e773-e780
        • Pilger D
        • von Sonnleithner C
        • Bertelmann E
        • Maier A-KB
        • Joussen AM
        • Torun N.
        Exploring the precision of femtosecond laser-assisted descemetorhexis in Descemet membrane endothelial keratoplasty.
        BMJ Open Ophthalmol. 2018; 3e000148
        • Miyata K
        • Kamiya K
        • Takahashi T
        • et al.
        Time course of changes in corneal forward shift after excimer laser photorefractive keratectomy.
        Arch Ophthalmol. 2002; 120: 896-900
        • Amigó A
        • Martinez-Sorribes P
        • Recuerda M.
        Refractive changes induced by spherical aberration in laser correction procedures: an adaptive optics study.
        J Refract Surg. 2017; 33: 470-474