case_images: PMC11250565_01
case_images: Examinations of the left eye at the first visit and after iris suturing and cortex removal. a Slit-lamp findings of the left eye showing residual cortex, iridodialysis, and corneal edema. b Specular microscopy image taken during the initial visit, showing the cornea. Due to significant corneal edema, endothelial cells are not discernible in this image. c, d Corneal edema is observed in the left eye by anterior-segment optical coherence tomography. CCT is 573 mum (c) with asymmetrical corneal edema (d). e Slit-lamp photo of the anterior segment 6 days after the procedure. The cornea is thickened and edematous. f, g Corneal edema is observed in the left eye after iris suturing and cortex removal. CCT measured by anterior-segment optical coherence tomography is 722 mum.
case_images: cop-2024-0015-0001-539392_F01.jpg
case_images: PMC11250565_01_cop-2024-0015-0001-539392_F01.jpg
case_images: F1
case_images: Slit-lamp examination revealed residual lens cortex in the anterior chamber, iridodialysis, and corneal edema in the left eye (Fig. 1a). Corneal endothelial cell density (ECD) could not be evaluated using noncontact specular microscopy, suggesting that it was below the minimum threshold for detection (Fig. 1b). Her central corneal thickness (CCT) was 573 mum as measured by anterior-segment optical coherence tomography (CASIA2, Tomey, Japan) (Fig. 1c, d). Postoperatively, the patient's BCVA in the left eye was recorded at 0.1, with a notable increase in the corneal thickness to 722 mum (as shown in Fig. 1e-g).
case_images: Clinical images after Descemet's stripping automated endothelial keratoplasty (DSAEK). a Photo of the anterior segment 3 weeks after DSAEK. The graft is detached from the host cornea. b Anterior segment optical coherence tomography 3 weeks after DSAEK. The graft is detached from the host cornea. c Anterior segment after the second tamponade. The graft suture is observed in the inferior part. The transparency of the host cornea is improved. d Anterior-segment optical coherence tomography 7 months after DSAEK. The graft is detached and shrunken, although attached at the sutured part. The CCT of the host cornea is 529 mum.
case_images: cop-2024-0015-0001-539392_F02.jpg
case_images: PMC11250565_01_cop-2024-0015-0001-539392_F02.jpg
case_images: F2
case_images: Although the corneal graft attached well without any space, it started to detach from the host cornea 3 weeks after surgery (Fig. 2a, b). Eight months after DSAEK, although the transplanted graft was highly opacified, the host corneal edema and transparency improved (Fig. 2c, d).
case_images: Clinical images after corneal graft removal from the anterior chamber. a Excisional specimen histology (Periodic acid-Schiff [PAS], x400) demonstrating preserved Descemet's membrane (blue arrow) and only a few remaining endothelial cells (red arrows). b One month post graft removal. Corneal transparency is maintained. c, d Anterior segment optical coherence tomography images of the patient 1 month after graft removal. Corneal thickness has improved to 580 mum, and corneal clarity is maintained. e Specular microscopy image captured after the removal of the graft. This image shows the corneal endothelial cells in the central area of the cornea with a density of 995 cells/mm2, where Descemet's membrane stripping was performed.
case_images: cop-2024-0015-0001-539392_F03.jpg
case_images: PMC11250565_01_cop-2024-0015-0001-539392_F03.jpg
case_images: F3
case_images: In the pathological examination, the removed corneal graft included scarce corneal endothelium cells (Fig. 3a). One month after graft removal, corneal graft clarity was maintained (Fig. 3b). CCT remained at 580 mum (Fig. 3c, d). Correction for the corneal irregular astigmatism with a rigid gas permeable lens resulted in a visual acuity of 0.8 10 weeks after graft removal. Subsequently, good corneal transparency and visual acuity were maintained for 4 months postoperatively, with an ECD of 995/mm2 (Fig. 3e).