Eyeworld

70 | EYEWORLD | SEPTEMBER 2019 C ORNEA by Stefanie Petrou Binder, MD EyeWorld Contributing Writer Contact information Mallias: johnmallias@yahoo.com I t's an unusual case study and one that occurred by mistake. Ioannis Mallias, MD, described the unexpected clinical picture and management of a patient who had a clear cornea after two simultaneous corne- al grafts, placed after two separate DSAEK surgeries. The 28-year-old male patient with congen- ital glaucoma presented at Dr. Mallias' clinic with two DSAEK grafts and a clear cornea. The patient was monocular, with BCVA 20/400 in his right eye, an ocular prosthesis in his left, and three antiglaucoma valve procedures dating back over many years. After cataract surgery, the patient devel- oped pseudophakic bullous keratopathy with chronic corneal edema. This corneal disease is characterized by corneal stromal edema with epithelial and subepithelial bullae, caused by cell loss and endothelial decompensation through trauma from cataract surgery. It affects 1–2% of cataract surgeries and is caused by heat-related phaco damage and oxidative stress, prolonged phaco, damage from turbulent flow from high irrigation/aspiration rates, and is as- sociated with Fuchs' dystrophy, certain types of Can two DSAEK grafts create a clear cornea? About the doctor Ioannis Mallias, MD Director of Laser Plus Eye Institute Athens, Greece Relevant financial interests Mallias: None glaucoma, and surgeries that can cause trauma and lead to endothelial cell loss, among other etiologies. Corneal transplantation is the gold stan- dard for the treatment of bullous keratopathy, allowing relief of symptoms, such as pain and tearing, and visual acuity recovery. The corneal graft success rate is high, however, there is also a risk of rejection. This patient's history revealed that he underwent endothelial keratoplasty twice. After the first of these corneal surgeries, the surgeon placed four cardinal sutures in the cornea, which when removed had left scars on the cor- nea. The first graft remained clear for 2 years until the recurrence of corneal edema, which led to graft failure, necessitating a new corneal transplantation. The second surgery was carried out by a different surgeon, who mistook the scars on the cornea from the preplaced cardinal sutures as resulting from a full thickness, penetrating keratoplasty (PK), when in fact the patient had undergone DSAEK. The miscommunication of the patient's clinical history and failure to identify DSAEK led to an error involving a Sumit "Sam" Garg, MD, and more from the ASCRS and ASOA Combined Ophthalmic Symposium

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