Posters

A severe corneal decompensation in an ICE syndrome patient treated successfully by Descemet's membrane endothelial keratoplasty (DMEK)

Poster Details

First Author: R.Kaufman ISRAEL

Co Author(s):    D. Wajnsztajn   D. Landua   B. Quizhpe   S. Frenkel   A. Solomon   I. Lavy     

Abstract Details

Purpose:

Iridocorneal endothelial (ICE) syndrome is a group of ocular pathologies characterized by proliferation and migration of aberrant corneal endothelial cells towards the iridocorneal angle and iris surface, causing a varying degree of corneal edema and decompensation, iris atrophy, and secondary angle-closure glaucoma. Herpes Simplex virus and Epstein-Barr virus may have a role in the pathogenesis. Due to the complex presentation, management of these patients can be challenging, especially concerning the technical difficulties of performing a Descemet Membrane Endothelial Keratoplasty (DMEK), when needed. Here, we would like to present the surgical steps of a successful DMEK in an ICE syndrome case.

Setting:

The cornea clinic and ophthalmological operating room at Hadassah Medical Center, a tertiary university hospital, in Jerusalem, Israel, between July 2017 to March 2018.

Methods:

A case report of an ICE syndrome patient with Progressive Iris Atrophy, comprised of a retrospective review of pre-op and post-op serial clinical examinations and imaging, including best corrected visual acuity, intraocular pressure measurements by Goldmann tonometry, Slit-lamp photographs and examination findings, Konan CellChek specular microscopy images, Casia SS-1000 Anterior Segment Optical Coherence Tomography (AS-OCT) images, surgical specimen’s histopathological slides and intraoperative video footage of the DMEK performed on the patient.

Results:

A 74-year-old female suffering from left eye ICE syndrome, presented with stable glaucoma under local treatment, corectopia, and corneal edema. Following an uneventful phacoemulsification surgery, the patient’s corneal decompensation and edema progressed, including endothelial detachment and recurrent events of Bullous Keratopathy causing corneal erosions, requiring bandage contact lens use. Therefore, despite limitations of severe edema and a shallow chamber with severe peripheral anterior synechiae, she underwent an uneventful DMEK, including mechanical synechiolysis and pupilloplasty. Three weeks post-op, the graft was attached and progressive clearing of the cornea was demonstrated, while the visual acuity improved and the patient was pain-free.

Conclusions:

In cases of a severe corneal decompensation in ICE syndrome patients, despite the technical difficulties, a successful DMEK may immensely improve the patient’s quality of life. As shown in our case, results may be noticed even a short time after surgery, though long term results are still pending.

Financial Disclosure:

None