Case Series: Novel Utilization of Rho-Kinase Inhibitor for the Treatment of Corneal Edema.

PURPOSE: To describe 3 cases of corneal clearance after the use of topical rho-kinase inhibitor, netarsudil, in the setting of endothelial cell dysfunction in comparison to one case without corneal clearance after the use of netarsudil. METHODS: Four patients presenting to a busy academic clinical corneal practice with visual complaints from corneal edema secondary to endothelial cell dysfunction were treated with topical netarsudil one drop daily in the affected eye. RESULTS: Corneal clearance was observed in 1) a case of peripheral corneal edema in the setting of iridocorneal endothelial syndrome after 4 weeks on netarsudil, 2) a case of corneal edema in the setting of early penetrating keratoplasty graft failure after 2-week use of netarsudil, and 3) a case of corneal edema in the setting of chronic penetrating keratoplasty graft failure after 4-week use of netarsudil. Corneal clearance was not observed in a case of corneal edema in the setting of pseudophakic bullous keratopathy from previous complicated intraocular lens exchange surgery with placement of an anterior chamber intraocular lens after the use of netarsudil for 12 weeks. CONCLUSIONS: Addition of topical rho-kinase inhibitor in the form of netarsudil can result in corneal clearance in a variety of certain cases of endothelial cell dysfunction, not previously documented in the literature.

Surgical outcomes of endothelial keratoplasty safety-basket suture for management of difficult cases.

OBJECTIVE: To report outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) safety-basket suture technique in complex eyes in which an air bubble could not be maintained in the anterior chamber. STUDY DESIGN: Retrospective chart review. PARTICIPANTS: Patient's undergoing DSAEK with use of the safety-basket suture technique in patients with corneal edema secondary to endothelial dysfunction with up to 3 years of follow-up between 2013 and 2016. METHODS: Outcome measures were corrected distance visual acuity, average endothelial cell count loss, graft decentration, graft detachment, rebubble rate, infection rate, graft rejection, and graft failure were analyzed. RESULTS: The technique was used successfully for 36 high-risk cases with no incidence of graft decentration, postoperative infection, or graft rejection. Both the graft detachment and rebubble rate was found to be 11.1%. The graft failure rate was found to be 22.2% with an average of 3.3 months, with 37.5% of these being primary failure and 62.5% of these being secondary failure. CONCLUSIONS: Endothelial keratoplasty safety-basket suture is a technique that can be beneficial in difficult DSAEK cases with a lower graft detachment rate compared with the current literature as well as a fairly low complication rate and graft failure while maintaining good visual outcomes. The safety-basket suture is the technique of choice for cases of aphakia and may allow for DSAEK in cases previously that may have only been considered for full-thickness keratoplasty.

Pterygium is related to a decrease in corneal endothelial cell density.

PURPOSE: The aim of this study was to investigate the relationship between pterygium and a decrease in the corneal endothelial cell density (ECD) in patients with unilateral primary pterygium. METHODS: In this retrospective cross-sectional study, 90 consecutive patients with unilateral primary pterygium were enrolled from January 2010 to June 2012. Corneal ECD was measured in both eyes, and the fellow eyes were considered as controls. The relationship between the percentage of pterygium to cornea and a decrease in the ECD was analyzed. An increase in astigmatism in eyes with pterygium was evaluated for association with decreased ECD using the Pearson correlation test. RESULTS: The percentage of pterygium to cornea ranged from 3.5% to 65.2%, with a median of 12.35%. The difference in the corneal ECD between eyes with pterygium and control eyes ranged from +9.6% to -37.7%, with a median of -9.75%. The results of the Pearson correlation statistical test showed a strong logarithmic correlation between a decrease in the corneal ECD and the percentage of pterygium to cornea (R = 0.688, P < 0.001). An increase in astigmatism was correlated with a decrease in the ECD in eyes with pterygium. CONCLUSIONS: Pterygium is related to a decrease in corneal ECD. Surgical intervention should be considered in patients with extensive pterygium involvement in the cornea or a significant increase in astigmatism.

[DMEK in corneal endothelial disorders: first Swiss consecutive series]. / DMEK bei Hornhautendothelerkrankungen: erste Serie in der Schweiz.

PURPOSE: The aim of this study was to analyse clinical and functional results after Descemet membrane endothelial keratoplasty (DMEK) as preferred technique in patients with Fuchs dystrophy and endothelial decompensation in a consecutive series. HISTORY AND SIGNS: In 12 eyes of 11 patients with Fuchs dystrophy or postoperative corneal decompensation a Descemet membrane endothelial keratoplasty as sole technique was indicated. All eyes were pseudophakic. Mean preoperative visual acuity was 0.25. Corneal stromal edema was observed since 18 months in mean. THERAPY AND OUTCOME: There were neither postoperative complications nor graft loss due to preparation. Mean follow-up time was 7 months. Stromal edema vanished within 4 weeks in mean. Postoperative visual acuity improved in all cases to 0.6 in mean. Neither immune reaction nor endophthalmitis nor primary graft failure were observed so far. Endothelial cell loss was 20% in mean. CONCLUSION: Descemet membrane endothelial keratoplasty seems to be a promising procedure. Long-term follow-up will show the real value of this exciting technique.