Posters

Bilateral DMEK in a patient with posterior polymorphous corneal dystrophy

Poster Details

First Author: E.Segovia Maldonado SPAIN

Co Author(s): P. Marti Rodrigo    R. Muñiz Vidal   J. Armentia Perez de Mendiola              

Abstract Details

Purpose:

To describe a 67 years old patient with posterior polymorphous corneal dystrophy (PPCD). Patient had amblyopia in his left eye (LE) with a potencial visual acuity (VA) of 20/40. He did not present ocular hypertension or glaucoma. He was diagnosed at the age of 66 with PPCD, Unilateral mild corneal oedema and corneal vesicles were noticed at the first examination, gonioscopy showed a grade 4 angle with some spread synechia. Patient initially improved with 5% sodium chloryde drops, but ended up needing a corneal graft.

Setting:

Patient assessed at Hospital de l'Esperança (Parc de Salut Mar)

Methods:

Patient presented aswell a mild cataract, aswell as corneal vesicles. At the initial exploration patient presented VA on his RE of 20/25 and in LE 20/40. Corneal oedema decreased LE VA to 20/200. Cataract extracion with intraocular lens and DMEK was then performed on LE. RE presented a mild cataract with a slight corneal oedema, and initially cataract extraction without DMEK was considered. Postoperative the patient presented both pseudophakic macular oedema and corneal oedema. DMEK had to be performed aswell as triamcinolone subtenon injection. One surprising finding was that corneal oedema was always predominant in the upper hemicornea.

Results:

Anatomical pathology failed to confirm the diagnosis of PPCD although confirmed the presence of descemet membrane. Anterior segment optical coherence tomography (AS-OCT) aswell as slit lamp examination supported the diagnose of PPCD. DMEK surgery was uneventful in both cases, the descemethorrexis was similar to any Fuchs endothelial dystrophy (FECD) patient. Patient had a complete visual recovery in both eyes with RE VA of 20/20 and LE of 20/40 with 6 months follow-up. No significant ocular hypertension had presented so far.

Conclusions:

Most of the cases of PPCD present with corneal vesicles with a broad spectrum of no simptoms to advanced glaucoma and corneal oedema. It's hard to explain why in both eyes the corneal oedema was predominant on the upper hemicornea In our case, DMEK was a good technique for resolving corneal oedema, finding no difficulties compared to any FECD. Final visual acuity was satisfactory, patient presented no other complications as glaucoma or ocular hypertension

Financial Disclosure:

None