Endoilluminator-assisted phacoemulsification and DMEK in severe endothelial decompensation due to angle closure glaucoma

Session Details

Session Title: Combined Cataract Surgery: Techniques/Practice Styles

Session Date/Time: Tuesday 13/09/2016 | 14:00-16:00

Paper Time: 14:54

Venue: Auditorium C6

First Author: : M.Ozmen TURKEY

Co Author(s): :    E. Yuksel   B. Aydin   F. Akata   K. Bilgihan           

Abstract Details

Purpose:

To report the clinical outcome of endoilluminator assisted phacoemulsification and DMEK in a patient with severe endothelial decompensation due to angle closure glaucoma.

Setting:

Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey

Methods:

A 60-year old male presented our clinic with endothelial decompensation. It is found that he had previous angle closure glaucoma attacks and had ndYAG laser peripheral iridotomy 6 months ago. His visual acuity was hand motion and intraocular pressure was 26mmHg with maximum topical anti-glaucoma medication. Scheimpflug imaging revealed that the anterior chamber (AC) angle was 15°. Central corneal thickness (CCT) was 950μ. DMEK with combined phacoemulsification was planned. During the surgery edematous epithelium was removed but visualization of the anterior capsule was not enough for continuous curvilinear capsulorhexis (CCC) even with the help of trypan blue.

Results:

Operating microscope’s light was turned off and an endoilluminator with a shielded tip was used through one of the side ports to reduce the scatter of the operating microscope’s light. After completing phacoemulsification a pre-prepared DMEK graft (2700cells/mm2) is introduced to the anterior chamber and unfolded with indirect manipulations. DMEK graft orientation was checked with the help of the endoilluminator. Air bubble is injected under the graft and operation is completed. The postoperative course was uneventful. No re-bubbling is required. At the postoperative 3rd month visit CCT was 537μ and AC angle was increased to 50°. Specular microscopy showed an endothelial cell count of 1800 cells/mm2. Intraocular pressure was 17mmHg without anti-glaucoma medication. Uncorrected visual acuity was 20/20.

Conclusions:

Endoilluminator assistance is helpful for visualization through highly edematous corneas both in phacoemulsification steps and DMEK graft orientation in combined surgeries. Phacoemulsification in combination with DMEK seems successful in treating endothelial decompensation and angle closure glaucoma with one operation.

Financial Disclosure:

NONE