Confocal microscopy after descemet stripping endothelial keratoplasty: a case report

To evaluate the clinical findings, visual outcomes, and confocal microscopic corneal features after Descemet stripping endothelial keratoplasty (DSEK) technique in Fuchs endothelial dystrophy.

A 70-year-old female patient with pseudophakia and Fuchs endothelial dystrophy underwent small-incision DSEK surgery. Best spectacle-corrected visual acuity was 1.30 (20/400) logarithm of the minimum angle of resolution (Snellen) before treatment. Confocal microscopy (ConfoScan 4; Nidek Technologies, Padova, Italy) was performed before surgery, after 7 days, at 1 month, and 6 months after descemet stripping endothelial keratoplasty. Images of corneal structures, including endothelium, donor stroma, and recipient stroma, were obtained.

Best spectacle-corrected visual acuity improved to 0.3 (20/40) logarithm of the minimum angle of resolution (Snellen) at 6 months. Endothelial cell density was 850 cells per square millimeter 6 months after surgery. Interface and donor stroma reflectivity were highest, 7 days postoperative showing progressive decrease over time.

The DSEK procedure represents a promising alternative to conventional penetrating keratoplasty for patients with Fuchs endothelial dystrophy. Confocal microscopy is able to detect interface morphological characteristics, to improve therapeutic choice, and to understand the pathophysiology of visual recovery.