Irregular Astigmatism after DSAEK

L.Avoni 1, L.Cappuccini 1, M.Busin 2

1 Department of Ophthalmology “Maggiore” Hospital – Bologna - Italy

2 Department of Ophthalmology “Villa Igea” Hospital – Forlì - Italy

CASE REPORTClinical Hystory Female - 15 Years Old

Misdiagnosis of CHED 1 in early life (RE > LE)

No Nystagmus

Visual Acuity Previous Values RE & LE 6/12 ( Snellen Fractions Based on 6m) (i.e 5/10) with refr: -3.00 sph -3.50 cyl x 180° (Moderate Amblyopia)

Reported a Deterioration of Visual Acuity over the years

CASE REPORTAt Our First Investigation:

Visual Acuity RE & LE rispectively 6/60 (i.e 1/10) with refraction of: -3.00 sph -3.50 cyl x 180° (?)

Anterior Segment RE & LE : Diffuse Serious Bilateral Haze

Fundus OO: Red Reflex Visible

CHED: note the diffuse serious bilateral corneal haze

OD OS

CHED: At this stage, which Clinical Strategies?

OD OS

Tests Carried Out Complete Eye Examination.

Photographs of Anterior Segment.

Orbscan Topography and Pachymetry.

Ultrasound Pachymetry.

Anterior Segment OCT (Casia)

Sirius Topography, Tomography, Pachimetry.

Corneal Topography (Orbscan) at Our First Investigation

SIMK’s Astigm 4,8 D @ 93°; MAX 45,7 D @93° / 40,9 D @ 3°

njnj

CASIA at Our First Investigation

Strategies and Management

DSAEK May 2011

Post Surgical Therapy : Topic Antibiotic & Steroid

Close Ophthalmological Examinations /Follow Up

Assess the use of a RGP Contact Lens to improve Visual Acuity

Corneal topography (Orbscan) After Surgery SIMK’s Astigm 18,3 D @ 65; MAX 53,1 D @65° / 34,8 D @ 155°

Casia topography After Surgery

Casia Tomography After Surgery

CASIA Pachimetry after Surgery

Corneal Topography (Sirius) 3 months after Surgery

Axial Algorithm

Corneal Topography (Sirius) 6 months after Surgery Axial Algorithm

SIMK’s after Surgery Axial Algorithm

SIMK’s 3 months after Surgery Axial Algorithm

SIMK’s 6 months after Surgery

Axial Algorithm

SIMK’s Astigm 18,3 D @ 65; MAX 53,1 D @65° / 34,8 D @ 155°

SIMK’s Pre SurgeryAxial Algorithm

SIMK’s Astigm 4,8 D @ 93°; MAX 45,7 D @93° / 40,9 D @ 3°

Corneal Topography(Sirius) 3 MonthsAfter Surgery(Local Algorithm)

NOTE THE CORNEAL SHAPE REGULARIZATION

Corneal Topography(Sirius) 6 MonthsAfter Surgery(Local Algorithm)

Corneal Pachymetry (Sirius) 6 Months After Surgery

i.e Thinnest Point

Corneal Pachymetry After Surgery

Corneal Pachymetry 6 months After Surgery

Thinnest Point : 840 μ

Thinnest Point : 586 μ

Corneal Tomography (Sirius) 3 months after Surgery (top) and 6 months after Surgery (bottom): note the reduction and the regularization of the corneal thickness.

OOPPPP

OOPPPP

Six Months After Surgery

Pre Surgery

Six months after Surgery

Current Results

Visual Acuity with RGPCL 6/12 (i.e 5/10)

Visual Acuity with refraction 6/12 : +3,75 sph – 2,75 cyl X 170°

IOP : 16mmhg

Anterior Segment: Considerably Reduction of Corneal Edema

Same Anterior Toricity as Before Surgical Treatment

Central Pachymetry: 600 μ

Discussion

CHED is characterized by a diffuse ground-glass appearance of both corneas and

markedly thickened (2-3 times thiker than normal) corneas from birth or infancy.

Two types of CHED are recognized: CHED 1 (autosomal dominant - the gene

responsible 1 has been mapped to the pericentromeric region of chromosome 20)

and CHED 2 (autosomal recessive).

CHED 1 becomes manifest during the first two years of life, but in contrast to CHED 2

nystagmus is absent.

The treatment is primarly surgical.

Discussion Several Authors (Busin M.; Busin M. et al) noted that DSAEK offers key

benefits over PK in conditions with moderate risk of graft failure (corneal

dystrophy).

Conclusions

In this patient DSAEK has resulted in a restoration of the corneal clarity with

a significant reduction of corneal astigmatism in few months.

The young patient reported a subjective significant improvement of visual

performance reporting also a considerably clearer vision.

An RGPCL with extremely high value of oxygen transmissibility was assed in

order to enhance the quality of vision.

At the moment the young patients is waiting for DSAEK in left eye.

L.Avoni , L.Cappuccini , M.Busin

Thank You for your Kind Attention

[email protected]