PMC6815562_01
Slit lamp biomicroscopy photos pre- and post-DSO surgery for the left eye. (a) Preoperative red reflex photo with a dilated pupil shows confluent guttae in the visual axis, slightly greater in the inferior half of the visual axis compared to superior half. The peripheral cornea is relatively spared of guttae. (b) Slit photo through the central cornea at 1 week post-DSO surgery demonstrates a. the edge of the descemetorhexis; b. guttae outside the area of Descemet's stripping; c. reticular epithelial edema; d. peripheral ring of corneal clearing without edema in presumed area of endothelial healing; and e. corneal stromal edema. (c) One month postoperative red reflex photo shows inferocentral descemetorhexis with clear visual axis without guttae and peripheral nonconfluent guttae.
CRIOPM2019-6139026.001.jpg
PMC6815562_01_CRIOPM2019-6139026.001.jpg
fig1
Her corneas had central confluent endothelial guttae in both eyes measuring 4.0 x 4.0 mm (right) and 3.8 x 4.0 mm (left) with associated stromal haze in both eyes (Figure 1(a)). Specular Microscope is not specified, but we suspect a midperipheral location based upon the distribution of guttae in the corresponding red-reflex image (Figure 1(a)). Scheimpflug tomography (Pentacam, Oculus, Inc., Arlington, WA) showed 2 diopters of regular with-the-rule astigmatism (Figure 3(a)). Her cornea showed removal of greatest area of guttae in her left eye measuring 4 mm (vertical) x 3.4 mm (horizontal), with slight inferior displacement of area of stripping relative to the pupil, corresponding to the area with densest guttae preoperatively (Figure 1(a)). The area of stripping was clearly delineated and edges of this area were noted to be clearing (Figure 1(b)).
Specular microscopy imaging of the corneal endothelium pre- and post-DSO surgery for the left eye. The locations (central, superior, inferior, nasal, and temporal) are based upon the standard gaze positions of the Konan specular microscope. Endothelial cell density (ECD) is indicated when measurable.
CRIOPM2019-6139026.002.jpg
PMC6815562_01_CRIOPM2019-6139026.002.jpg
fig2
The peripheral cornea showed scattered, nonconfluent guttae with cell densities of 1508-1550 cells/mm2 in the left eye (Figure 2). Specular microscopy (Konan) showed a central cell density of 754 cells/mm2 (Figure 2). Her central corneal endothelial cell density was 700 cells/mm2 and corneal pachymetry was 555 microm (Figures 2 and 3).
Sagittal corneal curvature, back surface elevation, and pachymetry maps pre- and post-DSO for the left eye.
CRIOPM2019-6139026.003.jpg
PMC6815562_01_CRIOPM2019-6139026.003.jpg
fig3
Specular Microscope is not specified, but we suspect a midperipheral location based upon the distribution of guttae in the corresponding red-reflex image (Figure 1(a)). Scheimpflug tomography (Pentacam, Oculus, Inc., Arlington, WA) showed 2 diopters of regular with-the-rule astigmatism (Figure 3(a)). The minimum central thickness was 593 microm in the left eye and the decreased back surface elevation suggested the presence of subclinical corneal edema (Figure 3(b)). Scheimpflug tomography imaging (Pentacam) showed inferocentral thickening and steepening in the area of Descemet's stripping (Figure 3(d)-3(f)). Scheimpflug tomography (Pentacam) showed a minimum central thickness at 565 microm (Figure 3(i)). Scheimpflug tomography (Pentacam) demonstrated decreased corneal thickness compared to all prior measurements for the left eye (Figures 3(l) and 4). Her central corneal endothelial cell density was 700 cells/mm2 and corneal pachymetry was 555 microm (Figures 2 and 3).
Corneal densitometries pre- and post-DSO for the left eye. Decrease in densitometry is noted not only in the posterior layer centrally (the region of Descemet's stripping), but also in the posterior layer peripherally and in the anterior layer throughout.
CRIOPM2019-6139026.005.jpg
PMC6815562_01_CRIOPM2019-6139026.005.jpg
fig5
Scheimpflug corneal densitometry showed improved (reduced) densitometry values from both the anterior and posterior corneal layers, and from the central and peripheral corneal zones compared to preoperatively (Figure 5). She continued to have pain in her left eye which did not respond to bandage contact lens placement but was alleviated with periodic use of fluorometholone 0.1% eye drops once daily as needed.