Spontaneous corneal clearing after Descemet's stripping without endothelial replacement

Area of Science:

• Ophthalmology
• Corneal Surgery
• Cell Biology

Background:

• Corneal edema due to endothelial dysfunction often requires endothelial keratoplasty.
• Descemet's stripping endothelial keratoplasty (DSEK) is a common surgical approach.
• This case explores an alternative to endothelial replacement.

Observation:

• A patient with Fuchs' endothelial dystrophy and posterior polymorphous membrane dystrophy underwent DSEK in one eye and Descemet's stripping alone in the other.
• Following graft failure and removal in the right eye, spontaneous clearing and endothelial cell repopulation occurred.
• The left eye, treated with Descemet's stripping alone, also demonstrated corneal clearing and endothelial cell repopulation.

Findings:

• Descemet's stripping alone facilitated corneal clearing and improved visual acuity.
• Confocal microscopy confirmed central endothelial cell repopulation in both eyes.
• Endothelial cell migration and host cell repopulation were observed post-procedure.

Implications:

• Descemet's stripping without endothelial replacement may be a viable option for specific endothelial dysfunctions.
• This approach highlights the potential for endogenous endothelial cell recovery.
• Further research is warranted to explore the efficacy and patient selection for this technique.