Management of descemetocele: Our experience and a simplified treatment algorithm

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dc.contributor.authorShankar, Sreeen_US
dc.contributor.authorAgarwal, Rinkyen_US
dc.contributor.authorNagpal, Rituen_US
dc.contributor.authorMaharana, Prafulla Ken_US
dc.contributor.authorGoel, Siddhien_US
dc.contributor.authorSinha, Rajeshen_US
dc.contributor.authorAgarwal, Tusharen_US
dc.contributor.authorTitiyal, Jeewan Singhen_US
dc.contributor.authorSharma, Namrataen_US
dc.date.accessioned2023-08-25T06:33:02Z
dc.date.available2023-08-25T06:33:02Z
dc.date.issued2022-05
dc.description.abstractPurpose: To formulate a treatment algorithm for the management of descemetocele. Methods: This was a prospective interventional study that was conducted at a tertiary eye?care center. All consecutive cases of descemetocele during the study period (April 1, 2017–March 31, 2018) were evaluated for the following parameters: age, sex, previous medical or surgical therapy, risk factors, preexisting ocular diseases, location, site and size of descemetocele, interventions undertaken, visual acuity, and the fellow eye status. The surgical modalities and fellow eye status were correlated individually with therapeutic and functional outcomes, based on which a treatment algorithm was formulated. Results: The study included 24 eyes of 24 patients (19M, 5F) with a median age of presentation of 45 years. The mean follow?up duration was 6.79 ± 3.97 months (3–12 months). The most common cause of descemetocele was microbial keratitis (66.66%), and most cases were central (50%), small (58.33%), and non?perforated (79.16%). The surgical interventions undertaken were cyanoacrylate glue (CG, 37.5%), penetrating keratoplasty (PKP, 33.33%), patch graft (16.66%), and deep anterior lamellar keratoplasty (DALK, 12.5%). Therapeutic success was noted in 13/24 eyes (54.16%). Final visual acuity > 3/60 was seen in 25% cases. Suboptimal therapeutic (P = 0.07) and visual (P = 0.34) outcomes were noted in subjects with non?functional fellow eye. Conclusion: PKP was preferred for descemetoceles with active microbial keratitis and extensive infiltrates, while CG and DALK were undertaken for healed microbial keratitis, neurotrophic keratitis, and ocular surface disorders with partial limbal stem cell deficiency (LSCD). For total LSCD, amniotic membrane graft was preferred.en_US
dc.identifier.affiliationsCornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Indiaen_US
dc.identifier.affiliationsDepartment of Ophthalmology, Lady Hardinge Medical College, New Delhi, Indiaen_US
dc.identifier.affiliationsAsian Institute of Medical Sciences, Faridabad, Haryana, Indiaen_US
dc.identifier.citationShankar Sree, Agarwal Rinky, Nagpal Ritu, Maharana Prafulla K, Goel Siddhi, Sinha Rajesh, Agarwal Tushar, Titiyal Jeewan Singh, Sharma Namrata. Management of descemetocele: Our experience and a simplified treatment algorithm. Indian Journal of Ophthalmology. 2022 May; 70(5): 1564-1570en_US
dc.identifier.issn1998-3689
dc.identifier.issn0301-4738
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/224342
dc.languageenen_US
dc.publisherAll India Ophthalmological Societyen_US
dc.relation.issuenumber5en_US
dc.relation.volume70en_US
dc.source.urihttps://doi.org/10.4103/ijo.IJO_3070_21en_US
dc.subjectAmniotic membraneen_US
dc.subjectcyanoacrylate glueen_US
dc.subjectdescemetoceleen_US
dc.subjectkeratoplastyen_US
dc.subjectkeratitisen_US
dc.titleManagement of descemetocele: Our experience and a simplified treatment algorithmen_US
dc.typeJournal Articleen_US
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