PMC9675345_01
Case 1 (A) Anterior segment photograph of the right eye revealing diminished corneal transparency due to central subepithelial and stromal fibrosis; (B) Linear microperforation in the donor-receptor area in the temporal side of the cornea noted during suturing (red arrow); (C) Postoperative status of the right eye - note the increased number of sutures around the donor-receptor opening (red arrow); (D) Anterior-segment optical coherence tomography showing a perfect apposition of the corneal graft.
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Biomicroscopy revealed diminished corneal transparency due to central subepithelial and stromal fibrosis, high irregular astigmatism attributable to late ectasia recurrence, and cataract (Figure 3A). While suturing the donor graft, an opening of the donor-receptor area in the temporal side of the cornea was detected (Figure 3B). This intraoperative complication was easily solved by adding more sutures in that area (Figure 3C). Twelve months after surgery, the corneal graft remained fully transparent, perfectly positioned (Figure 3C and D), and CDVA increased to 20/32.
PMC9675345_02
Case 2 (A) Anterior segment photography of right eye displaying lipid keratopathy (with subepithelial and stromal fibrosis) and corneal neovascularization; (B) Preoperative anterior segment photography of the left eye revealing stromal fibrosis and corneal neovascularization; (C) Intraoperative complication during left eye surgery - linear peripheric microperforation between I and II hours in the previous donor-host region (red arrow); (D and E) Postoperative anterior segment photographs of the right and left eye, respectively. (F) Anterior-segment optical coherence tomography of both eyes - note the perfect apposition of the corneal graft. AS-OCT.
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Biomicroscopy revealed diminished corneal transparency due to long-standing lipid keratopathy (with subepithelial and stromal fibrosis) and corneal neovascularization in the OD and stromal fibrosis and corneal neovascularization in the OS (Figure 4A and B, respectively). During the OS surgery, a linear peripheric microperforation in the donor-receptor area during stromal dissection was observed and easily controlled with viscoelastic (Figure 4C). Due to his autoimmune background and inflammatory response, an amniotic membrane was applied to both anterior surfaces. At the twelfth-month appointment of OD and OS, both corneas were transparent, the grafts were perfectly positioned (Figure 4D-F), and the patient presented a CDVA of 20/63 in his OD and 20/40 in his OS.
PMC9675345_03
Case 3 (A) Preoperative anterior segment photo with diminished corneal transparency due to stromal fibrosis; (B) Graft after twelve months of surgery; (C) anterior-segment optical coherence tomography shows a perfect apposition between layers.
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After six months of DMEK surgery, the patient presented with progressively diminished visual acuity in her OD - 20/125 - due to central stromal fibrosis (Figure 5A) despite functional endothelium (1001 cells/mm2). At the twelfth month postoperative appointment, CDVA increased to 20/40 in her OD, and the cornea was transparent (Figure 5B and C).