Eyeworld

111 EW INTERNATIONAL September 2017 efficient, and safe outcomes in eyes lacking an intact capsule, especially for post-keratoplasty patients with secondary IOLs and without capsu- lar support." Dr. Antunes' case study demon- strated the safety and reliability of DSAEK in cases of multiple ocular comorbidity. "Today in the DMEK era, I think that DSAEK has an important place. We used it in this high risk case, in which there was both an elevated risk of hemor- rhage and a real risk of losing the eye completely due to the multiple procedures. It was very safe and easy to perform. Although it is important to strip Descemet's membrane when the basic pathology is Fuchs' corneal dystrophy, it was not necessary here," he said. EW Contact information Antunes: contato@ioa.com.br Walsh: acrema@openlink.com.br Eyes with multiple trauma can seem impossible to treat, according to Victor Antunes, MD, director of the Instituto de Oftalmologia de Assis, Assis, Sao Paulo, Brazil, who report- ed on a 56-year-old male patient who was referred to Dr. Antunes' clinic for a corneal evaluation due to frequent pain in his left eye. The pa- tient had suffered widespread ocular trauma from a motorcycle accident in 1997. Past surgeries included vitrectomy (1997), trabeculectomy (1998), Ahmed tube shunt (2000), intracapsular cataract extraction and anterior chamber IOL (2003), pupilloplasty (2004), penetrating keratoplasty (PK) (2007), second PK (2010), Ahmed shunt revision (2013), second Ahmed tube shunt, and posterior vitrectomy (2014). An eye exam revealed hand movement vision and IOP of 12 mm Hg in the left eye, which had a failed PK with multiple epithelial blisters, AC IOL, a tube shunt in the anterior chamber and another one in the pos- terior chamber. The left fundus exam was unremarkable, with laser marks visible in the retinal periphery. The right eye revealed visual acuity of 20/25 with IOP of 16 mm Hg, a clear cornea, a superior iridectomy, a superior trabeculectomy, and the IOL in place. The fundus exam of the right eye showed a normal macula. The patient had arterial hyperten- sion and his family history revealed glaucoma on his father's side. Dr. Antunes decided on a surgi- cal plan for the left eye that includ- ed Descemet's membrane stripping automated endothelial keratoplasty (DSAEK), explantation of the AC IOL, plus a PC IOL with scleral fixa- tion. He prepared, removed, and re- placed the irregular corneal segment, removed the IOL from the anterior chamber, and placed and fixated the posterior chamber IOL in the sulcus. The patient was very satisfied postoperatively, with no pain and an improvement of left eye vision from hand motion vision to 20/100. "We did not strip the endo- thelium in this case and there was no need to. We replaced the cor- neal segment down to Descemet's membrane, put the new graft in place and added an air bubble," he said. "I was expecting a very hard case but everything went smoothly, most likely because we spared the endothelium. When you strip the endothelium, you risk opening the cornea and the penetrating kerato- plasty incision. In post-keratoplasty corneas, Descemet's membrane can be very atrophic and you can also damage the stroma if you try to strip it. This patient had a very thin, compensated endothelium. In cases of limited visual acuity prognosis, DSAEK is my first option. The more complicated the case is, the more important it is to be sure that each procedure you do is safe and pre- dictable. DSAEK gives reproducible, 800.354.7848 TOLL FREE IN THE USA | +1.859.259.4924 WORLD WIDE | stephensinst.com S9-2070 S9-2060 S9-2065 As we celebrate 40 years of service to the ophthalmic community, we recognize those doctors who have grown along with us. Just like our instruments, our reputation for value, service and reliability has been crafted to last a lifetime. "I have used Stephens ophthalmic instruments since I went into practice—forty years ago. When I need new microsurgical instruments, I look to Stephens first." JOHN E. DOWNING, MD Bowling Green, Kentucky © 2017 Stephens Instruments. All rights reserved. For more information visit us at AAO booth #3540

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