Re-Descemet Membrane Endothelial Keratoplasty (DMEK) con preservación del injerto original tras free roll en cámara anterior: a propósito de un caso / Re-descemet membrane endothelial keratoplasty (DMEK) with preservation of the original graft after free-roll in the anterior chamber: a case report

Introducción: Las queratoplastias lamelares han supuesto un gran impacto en el manejo del edema corneal por disfunción endotelial. Las técnicas de trasplante mínimamente invasivo como la Descemet Membrane Endothelial Keratoplasty (DMEK) han permitido reducir la morbilidad que suponía la realización de una queratoplastia penetrante en este tipo de pacientes. Aun así, se trata de técnicas complejas que no están exentas de complicaciones, y que requieren una larga línea de aprendizaje quirúrgico y una aún más exigente experiencia en el manejo postoperatorio.Caso clínicoUna mujer de 89 años afecta de distrofia endotelial de Fuchs e intervenida de cirugía combinada de catarata y DMEK, presentó a las 24h de la intervención un edema estromal de predominio inferior y un despegamiento sectorial del injerto. Tras un re-bubbling en consultas y 4 días más tarde, se observó el injerto enrollado y libre en cámara anterior.Se intervino de re-DMEK con preservación del injerto original tras 24h, con desepitelización para optimizar la visualización. Se tiñó el injerto con azul tripán y se protegió el estroma posterior con aire. Se reimplantó el injerto bajo maniobras intraoculares y con burbuja de aire.A las 24h de la cirugía se observó el injerto adherido, con una gran disminución del edema estromal. Un mes después, la paciente presentaba una córnea transparente, una persistente adhesión completa del injerto y una agudeza visual de 0,9.ConclusiónEl hallazgo del free roll en cámara anterior tras cirugía de DMEK constituye la forma más compleja de despegamiento del injerto. El edema corneal, así como la disposición de las diferentes estructuras intraoculares son condicionantes a tener en cuenta para la resolución quirúrgica de esta complicación. En muchos casos el reposicionamiento quirúrgico del injerto es factible, hecho que implica ahorrar costes sin necesidad de utilizar nuevos tejidos corneales donantes. (AU)

Introduction: Lamellar keratoplasties have had a great impact in the management of corneal edema due to endothelial dysfunction. Minimally invasive transplant techniques such as descemet membrane endothelial keratoplasty (DMEK) have helped to reduce the morbidity involved in performing penetrating keratoplasty in this type of patient. Even so, these are complex techniques that are not free of complications and require a long line of surgical learning and an even more demanding experience in postoperative management.Clinical caseAn 89-year-old woman suffering from Fuchs endothelial dystrophy and undergoing combined cataract and DMEK surgery presented stromal edema predominantly inferior and sectoral detachment of the graft 24h after the intervention. After re-bubbling in consultations and 4 days later, the graft was observed rolled and free in the anterior chamber.She underwent re-DMEK with preservation of the original graft after 24h, with de-epithelialization to optimize visualization. The graft was stained with trypan blue and the posterior stroma was protected with air. The graft was reimplanted under intraocular maneuvers and with an air bubble.Twenty four hours after surgery, the adhered graft was observed, with a great decrease in stromal edema. One month later, the patient had a clear cornea, persistent complete graft adhesion, and visual acuity of 0.9.ConclusionThe discovery of free roll in the anterior chamber after DMEK surgery constitutes the most complex form of graft detachment. Corneal edema as well as the arrangement of the different intraocular structures are conditions to be considered for the surgical resolution of this complication. In many cases, surgical repositioning of the graft is feasible, which means saving costs without the need to use new donor corneal tissues. (AU)

Re-descemet membrane endothelial keratoplasty (DMEK) with preservation of the original graft after free roll in anterior chamber: A case report.

INTRODUCTION: Lamellar keratoplasties have had a great impact in the management of corneal edema due to endothelial dysfunction. Minimally invasive transplant techniques such as Descemet Membrane Endothelial Keratoplasty (DMEK) have helped to reduce the morbidity involved in performing penetrating keratoplasty in this type of patient. Even so, these are complex techniques that are not free of complications and require a long line of surgical learning and an even more demanding experience in postoperative management. CLINICAL CASE: An 89-year-old woman suffering from Fuchs endothelial dystrophy and undergoing combined cataract and DMEK surgery presented stromal edema predominantly inferior and sectoral detachment of the graft 24 h after the intervention. After re-bubbling in consultations and 4 days later, the graft was observed rolled and free in the anterior chamber. She underwent re-DMEK with preservation of the original graft after 24 h, with de-epithelialization to optimize visualization. The graft was stained with trypan blue and the posterior stroma was protected with air. The graft was reimplanted under intraocular maneuvers and with an air bubble. 24 h after surgery, the adhered graft was observed, with a great decrease in stromal edema. One month later, the patient had a clear cornea, persistent complete graft adhesion, and visual acuity of 0.9. CONCLUSION: The discovery of free roll in the anterior chamber after DMEK surgery constitutes the most complex form of graft detachment. Corneal edema as well as the arrangement of the different intraocular structures are conditions to be considered for the surgical resolution of this complication. In many cases, surgical repositioning of the graft is feasible, which means saving costs without the need to use new donor corneal tissues.

Hemorragia supracoroidea diferida después de queratoplastia endotelial automatizada con pelado de la membrana de Descemet (DSAEK) / Delayed suprachoroidal hemorrhage after descemet stripping automated endothelial keratoplasty (DSAEK)

Este estudio, una serie de 2casos y revisión de la literatura, pretende describir el segundo y tercer caso conocido de hemorragia supracoroidea diferida (DSCH) tras una queratoplastia endotelial automatizada con pelado de Descemet (DSAEK). La hemorragia supracoroidea consiste en la presencia de sangre en el espacio supracoroideo. La agudeza visual final no suele superar el 0,1 (escala decimal). Ambos casos presentan factores de riesgo: alta miopía, cirugía intraocular previa, hipertensión arterial o estar anticoagulados. El diagnóstico de hemorragia supracoroidea diferida se realizó en la primera visita de seguimiento: referían dolor intenso y agudo horas después de la cirugía. Fueron tratados con drenaje transescleral. La hemorragia supracoroidea diferida es una complicación rara pero devastadora y puede ocurrir después de un trasplante lamelar, como la queratoplastia endotelial automatizada con pelado de Descemet. Conocer esta complicación así como sus factores de riesgo permitirá un diagnóstico precoz, lo que mejorará el pronóstico de los pacientes (AU)

This study, a case series of 2patients and a literature review, aims to describe the second and third known cases of delayed suprachoroidal hemorrhage after Descemet stripping automated endothelial keratoplasty (DSAEK). The suprachoroidal hemorrhage is defined as the presence of blood in the suprachoroidal space; final visual acuity is rarely greater than 0.1 (decimal scale). Both cases presented had known risk factors: high myopia, previous ocular surgeries, arterial hypertension, and being under anticoagulant therapy. The diagnosis of delayed suprachoroidal hemorrhage was made at the 24-hour follow-up visit, as they recalled a sudden and tremendous acute pain hours after surgery. Both cases were drained through a scleral approach. Delayed suprachoroidal hemorrhage is a rare but devastating consequence that can occur after DSAEK. Awareness of the most critical risk factors allows for early identification, which is of paramount importance for the prognosis of these patients (AU)

Delayed suprachoroidal hemorrhage after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).

This study, a case series of 2 patients and a literature review, aims to describe the second and third known cases of delayed suprachoroidal hemorrhage after Descemet stripping automated endothelial keratoplasty. The suprachoroidal hemorrhage is defined as the presence of blood in the suprachoroidal space; final visual acuity is rarely greater than 0.1 (decimal scale). Both cases presented had known risk factors: high myopia, previous ocular surgeries, arterial hypertension, and being under anticoagulant therapy. The diagnosis of delayed suprachoroidal hemorrhage was made at the 24-h follow-up visit, as they recalled a sudden and tremendous acute pain hours after surgery. Both cases were drained through a scleral approach. Delayed suprachoroidal hemorrhage is a rare but devastating consequence that can occur after Descemet stripping automated endothelial keratoplasty. Awareness of the most critical risk factors allows for early identification, which is of paramount importance for the prognosis of these patients.

Queratitis secundaria a Fusarium spp. en España 2012-2014 / Keratitis secondary to Fusarium spp. in Spain 2012-2014

OBJETIVO: Describir las características clinicoepidemiológicas de una serie de casos de queratitis fúngica asociada con Fusarium spp., en España durante los años 2012 a 2014. MÉTODOS: Estudio retrospectivo de una serie de casos. Se identificaron los centros sanitarios que se encontraban en las capitales provinciales (n = 250), obteniéndose una muestra aleatoria sistemática del 10%. Se les preguntó si habían presentado casos de queratitis por Fusarium spp. caracterizados mediante métodos microbiológicos, 23 centros respondieron, detectando casos en 14 de ellos, aceptando participar 13, completando el estudio 11 instituciones, a los que se les envió el cuestionario previamente validado. Las variables analizadas fueron: edad, sexo, residencia habitual, profesión, antecedentes patológicos y médicos (enfermedades sistémicas y oculares previas, cirugías oculares previas) y su evolución. RESULTADOS: La tasa de respuesta fue del 92%, identificando 23 casos de Fusarium spp.; 21 casos (91,3%) vivían en zonas urbanas. Los profesionales fueron los más afectados por la enfermedad (chef, administrativo, técnico) con 13 casos (56,5%). Las pautas de tratamiento establecidas antes de la confirmación de la infección evidenciaron el uso combinado de antibióticos tópicos asociados a agentes antivirales y/o antifúngicos, siendo el principal factor de riesgo el uso de lentes de contacto (86,9%). DISCUSIÓN: Es una enfermedad poco frecuente en nuestro medio, un gran porcentaje de las personas residían en áreas urbanas y su trabajo se realizaba en entornos cerrados, enfocando la atención en los microtraumas causados por el uso de lentes de contacto

OBJECTIVE: To describe the clinical-epidemiological characteristics of a case series of fungal keratitis associated with Fusarium spp.., in Spain during the years 2012 to 2014. METHODS: A retrospective study of a case series was conducted on a systematic random sample of 10% of patients identified in Health Centres of provincial capitals (n = 250). The centres were asked whether they had been presented with cases of Fusarium spp. keratitis characterised by microbiological methods. Of the 23 centres that responded, 14 had detected cases, with 13 of them accepting to participate, and 11 of them completing the study. The latter being sent a previously validated questionnaire. The variables analysed were: age, gender, habitual residence, profession, disease and medical history (previous systemic and ocular diseases, previous eye surgeries), and their outcomes. RESULTS: The response rate was 92%, identifying 23 cases of Fusarium spp.. of which 21 (91.3%) of them lived in urban areas. The professions most affected by the disease included chefs, administrative, and technical, with 13 cases (56.5%). The treatment guidelines established to confirm the infection showed the combined use of topical antibiotics associated with antiviral and/or antifungal agents. The use of contact lenses (86.9%) was the main risk factor. DISCUSSION: This study showed that this is a rare disease in Spain, but that a large percentage of people who present with the disease are resident in urban areas, and they work in closed environments, focusing attention on microtraumas caused by use of contact lenses

Keratitis secondary to Fusarium spp. in Spain 2012-2014. / Queratitis secundaria a Fusarium spp. en España 2012-2014.

OBJECTIVE: To describe the clinical-epidemiological characteristics of a case series of fungal keratitis associated with Fusarium spp.., in Spain during the years 2012 to 2014. METHODS: A retrospective study of a case series was conducted on a systematic random sample of 10% of patients identified in Health Centres of provincial capitals (n=250). The centres were asked whether they had been presented with cases of Fusarium spp. keratitis characterised by microbiological methods. Of the 23 centres that responded, 14 had detected cases, with 13 of them accepting to participate, and 11 of them completing the study. The latter being sent a previously validated questionnaire. The variables analysed were: age, gender, habitual residence, profession, disease and medical history (previous systemic and ocular diseases, previous eye surgeries), and their outcomes. RESULTS: The response rate was 92%, identifying 23 cases of Fusarium spp.. of which 21 (91.3%) of them lived in urban areas. The professions most affected by the disease included chefs, administrative, and technical, with 13 cases (56.5%). The treatment guidelines established to confirm the infection showed the combined use of topical antibiotics associated with antiviral and/or antifungal agents. The use of contact lenses (86.9%) was the main risk factor. DISCUSSION: This study showed that this is a rare disease in Spain, but that a large percentage of people who present with the disease are resident in urban areas, and they work in closed environments, focusing attention on microtraumas caused by use of contact lenses.