Outcomes of descemetorrhexis without endothelial keratoplasty without Rho kinase inhibitors in Fuchs corneal dystrophy

Authors: Nicolas Kahuam , Alfonso Iovieno, Sonia N. Yeung.  University of British Columbia.

Author Disclosures: N. Kahuam:  None.  A. Iovieno:   None.  S. Yeung:  None.

Abstract Body: 

Purpose:  To report the outcomes of a series of cases of Descemetorhexis Without Endothelial Keratoplasty performed for Fuchs endothelial corneal dystrophy without the use of Rho-kinase (ROCK) inhibitors  

Study Design:   Retrospective Case Series.   

Methods:  A retrospective chart review was conducted on patients who underwent Descemetorhexis Without Endothelial Keratoplasty (DWEK) performed at the Cornea Service in the Department of Ophthalmology and Visual Sciences of the University of British Columbia from 2018 to 2022. DWEK was performed with a standard “stripping” technique and a 4 mm descemetorhexis. Inclusion criteria were patients with Fuchs endothelial corneal dystrophy with central guttae, no clinically significant corneal edema and peripheral corneal clarity as diagnosed by a corneal specialist.  

Results:  A total of 16 eyes from 11 patients were included in the study. Of these, 13 eyes underwent a combined DWEK + cataract extraction and intraocular lens implantation and 3 eyes underwent DWEK alone. Eight eyes (50%) were from female participants, 10 eyes were right and 6 were left. The mean best corrected visual acuity (BCVA) pre-operative was 0.45 LogMAR (SD 0.18), BCVA 1 week, 1 month, 2 months, 6 months and 12 months after surgery were 1.30 (SD 0.45), 0.48 (SD 0.17), 0.30 (SD 0.14), 0.24 (SD 0.20) and 0.16 (SD 0.05), respectively. The mean pachymetry pre-operative was 614 (SD 45.06) and the mean post-operative pachymetry was 603 (SD 32.52). Two eyes developed cystoid macular edema   

Conclusions:  Descemetorhexis Without Endothelial Keratoplasty is a viable option for selected cases of Fuchs endothelial corneal dystrophy where guttae are mainly located at the central cornea. With accurate patient selection and adequate surgical technique, DWEK can be performed successfully without the use of ROCK inhibitors.