A clinical case of endothelial corneal dystrophy

Relevance Fuchs' endothelial dystrophy is a progressive disease characterized by asymmetric, bilateral, slowly progressing edema. The main goal of therapy is to try to minimize chronic edema and associated symptoms of discomfort and decreased visual acuity [1]. A radical pathogenetically oriented method of treating Fuchs' ED is keratoplasty, which includes replacement of the altered endothelial layer [2]. The main goal of various modifications of penetrating keratoplasty ultimately comes down to restoring corneal transparency [3]. Objective To describe a case of epikeratoplasty in a patient with endothelial corneal dystrophy after SKP. Material and methods Analysis of data of a 77-year-old patient who applied to the Research Institute of Eye Diseases in August 2024 with complaints of low visual acuity OS. History of OU EDR, 2018 OS FEK + IOL. Since 2021, gradual vision loss in OS. Objectively OS counting fingers near the face; IOP 15 mm Hg by palpation. OS cornea: cloudy, large bullae on the epithelial surface, edematous stroma, thickened optical section, folds of Descemet's membrane. CL is worn, mobile. OS diagnosis: bullous keratopathy. SCP was performed. Results October: OS penetrating graft is transparent, epithelialized, sutures are clean, edges are adapted. After 2 weeks: CL is worn, mobile. December: dystrophic changes in the epithelium on the periphery of the graft were detected. January: penetrating graft is translucent in the lower 1/2, transparent in the upper. After 2 weeks: condition after SKP, long-term non-healing erosion of the penetrating graft with signs of keratomalacia. Epikeratoplasty was performed. First day after surgery: the epigraft is cloudy, completely covers the cornea, fixed to the episclera with interrupted sutures. Sutures are sound. Objectively at the time of discharge: OS hand movement near the face, n/corr. Modern methods of treatment and prevention of tissue incompatibility reaction of the corneal graft in patients are often ineffective. Patients with impaired immune privilege, who require keratoplasty to restore vision, belong to the high-risk group with a high probability of developing a tissue incompatibility reaction and opaque engraftment of the graft [4]. Persistent erosion of the corneal graft is a common complication of penetrating keratoplasty [5]. Conclusion Methods of treatment and prevention of tissue incompatibility reaction in corneal transplantation in high-risk patients are often ineffective. The main method of treatment of endothelial dystrophy remains keratoplasty, the main goal of which is to restore corneal transparency. Keywords: keratoplasty; cornea; endothelial corneal dystrophy