Mathematical model of corneal reendothelialization after inadvertent descemetorhexis

• Published in: Acta ophthalmologica (Oxford, England) England), 2014-09, Vol.92 (s253), p.0-0
• Main Authors: TRONE, M, JULIENNE, R, RANNOU, K, BERNARD, A, HE, Z, GAVET, Y, THURET, G, GAIN, P
• Format: Article
• Language: English
• Subjects: Ophthalmology
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/j.1755-3768.2014.2436.x

Purpose To report a case of inadvertent descemetorhexis during phacoemulsification and our conservative approach based on the endothelial cells (EC) self‐healing capacity Methods A 85‐year‐old man presented with an unusual complication of cataract surgery. During visco injection, the Descemet was accidentally dissected and removed during the capsulorhexis. On the next day, a massive corneal edema was observed. Based on the self‐healing capacity of the residual peripheral ECs, we proposed to observe the natural course. The posterior corneal surface geometry was measured in OCT (CASIA‐SS‐1000) and the residual endothelial area was calculated from a mathematical hemi‐ellipsoid model. Considering the EC density (ECD) from the fellow eye, we estimated the theoretical residual EC pool and thus the final post redistribution ECD in the patient. Results The theoretical ECD after endothelial cell redistribution was 1680 cells/mm2, reinforcing the wait and see strategy. Visual acuity improved from counting fingers initially to 20/40 at 8 months. The central cornea was clear and 540µm thick. Specular microscopy and confocal microscopy confirmed the repopulation of the central defect by the ECs over the denuded posterior stroma. The central ECD measured at 5 months and 8 months were 550 and 516 cells/mm2 respectively. Conclusion The ECD was less than expected suggesting a higher traumatic loss and a larger defect. The originality lies in the mathematical modeling of the spontaneous self‐healing capacity of the endothelium, deferring penetrating or endothelial keratoplasty. Interestingly, despite the 85 years old, ECs keep important migration and enlargement capacities. Grant: ANR/CORRIMO3D