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Case 2 - DSEK

This is a case of a 71 year old male that has had many previous eye surgeries including cataract extraction and a glaucoma tube implant.  He had developed a bullous keratopathy and was seeking a corneal tranplant surgery.  A Descemet Stripping Automated Endothelial Keratoplasty (DSAEK or DSEK) was performed for him.

The DSEK button was attached from the beginning, however there was a small wrinkle noted in the tissue.  Decision was made to observe.

Croneal edema after DSEK in the area of the fold

 

At one month after the surgery, the cornea was clear over 2/3 of the graft, however the area of the 1/3 of the cornea where a wrinkle was present, was very edematous.Corneal Fold seen on the slit lamp beam

 

 

 

 

 

 

Visante image of a DSEK fold

This fold is a direct result of curvature mis-match between the host corneal curvature and the grafts' corneal curvature.  The excess tissue falls into a wrinkle to accomodate the rest of the corneal tissue.  The area of corneal edema over time became smaller and smaller, until complete resolution in 6 months.

Corneal Fold of the DSEK button resolved after 6 months

 

The Cornea is now noted to be clear without any edema.  The wrinkle can still be seen from paracentral to 7:30 position in the peripheral graft.

The wrinkle in the DSEK button extending from paracentral cornea to 7:30 peripherally

 

 

 

 

 

Below is a visante image of the cornea showing the glaucoma tube implant at the edge of the corneal DSEK graft and the wrinkle in the DSEK tissue.  The patient is very happy with the total outcome.

 

Visante Image of the DSEK wrinkle also showing the glaucoma tube implant


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