Corneal calcification typically progresses slowly but can occasionally advance rapidly. This report details severe stromal calcification following repeat Descemet\'s stripping automated endothelial keratoplasty (DSAEK) in a 75-year-old patient with diabetes, hypertension, and prior ocular surgeries, including cataract surgery, intraocular lens extraction with suturing, and trabeculectomy. Persistent epithelial defects after the surgery led to rapid central stromal calcification within four weeks, significantly reducing visual acuity. Management included switching from betamethasone sodium phosphate to fluorometholone, facilitating complete epithelial recovery within two months. However, persistent stromal opacity necessitated a subsequent penetrating keratoplasty. Infrared absorption spectrophotometry identified calcium phosphate as the primary component of the calcification. This case highlights the importance of vigilant monitoring and proactive management of epithelial defects to prevent rapid calcification following endothelial keratoplasty.

UNASSIGNED: Postoperative hydrophilic intraocular lens opacification can lead to decreased vision and may require intraocular lens exchange. This study aims to identify the incidence of scleral-fixated Akreos AO60\'s (Bausch + Lomb) lens opacification and risk factors for this phenomenon.
UNASSIGNED: This is a retrospective case series of all patients who underwent scleral-fixated Akreos AO60 lens at our institution between January 1, 2015 and December 31, 2019. The following data were recorded: age, sex, medical history, indication for Akreos AO60 implantation, laterality, ocular history, previous ocular surgical procedures, subsequent intraocular surgical procedures after the Akreos implantation, lens opacification, visual significance of opacification, and Akreos explantation. Intraoperative and postoperative complications were recorded. Main outcome measures were the overall incidence of Akreos lens opacification as well as the incidence of these eyes undergoing subsequent intraocular surgery.
UNASSIGNED: A total of 262 eyes of 257 patients underwent Akreos lens implantation. Overall, 2% (5 of 262) developed lens opacification. Two patients had Descemet stripping automated endothelial keratoplasty (DSAEK) concurrently with Akreos implantation. One patient underwent subsequent Baerveldt glaucoma implantation and DSAEK. The fourth patient had vitrectomy with sulfur hexafluoride gas followed by DSAEK. This represents a 25% (4 of 16) opacification rate among all patients who underwent DSAEK (P ≤ .01, Fisher exact test). One patient developed opacification after undergoing 2 vitrectomies for retinal detachment in the absence of DSAEK.
UNASSIGNED: Akreos lens opacification can be visually significant and may occur after a retinal or corneal procedure that involves the use of intraocular gas or air.

The two most used modifications of endothelial keratoplasty (EK) are Descemet\'s membrane endothelial keratoplasty (DMEK) and Descemet\'s stripping automated endothelial keratoplasty (DSAEK). The leading complication of EK surgeries is graft detachment in the early postoperative period. This article reports on two cases of endothelial graft adhesion depending on morphological characteristics of the Descemet\'s membrane (DM) removed during EK. In the first case, complete graft attachment to the recipient\'s posterior stroma was observed after DMEK. Morphological analysis of the DM showed clean stromal surface. In the second case there was a false chamber between the endothelial transplant and the posterior stroma of the patient. OCT scans revealed separate stromal fibers protruding into the false chamber; morphological analysis of the removed DM showed stromal fragments fixed to the anterior surface of the DM. The revealed changes indicate damage to the posterior stroma the suffered received during descemetorhexis, which may be the cause for incomplete graft attachment. Complete attachment after repeated EK (DSAEK) in this case was due to a thin stromal layer on the graft that provided high degree of adhesion to the posterior corneal surface. DSAEK can be indicated as a repeated EK surgery in cases of persistent endothelial graft non-attachment after DMEK.
Основными модификациями эндотелиальной кератопластики (ЭК) считают изолированную трансплантацию десцеметовой мембраны (ДМ) с эндотелием (Descemet membrane endothelial keratoplasty, DMEK) и автоматизированную ЭК (Descemet stripping automated endothelial keratoplasty, DSAEK). Ведущим послеоперационным осложнением ЭК является возникновение ложной камеры между трансплантатом и роговицей реципиента. В статье представлены два клинических наблюдения адаптации эндотелиального трансплантата в зависимости от морфологических особенностей ДМ, удаленной при ЭК. В первом случае после DMEK отмечается полное прилегание трансплантата к строме реципиента по данным оптической когерентной томографии (ОКТ). При морфологическом исследовании визуализируется гладкая стромальная поверхность удаленной ДМ. Во втором наблюдении выявлена ложная камера между эндотелиальным трансплантатом и задней стромой реципиента. При ОКТ обнаружены отдельные стромальные волокна, проминирующие в ложную камеру; при морфологическом анализе удаленной ДМ реципиента отмечены фрагменты стромы, фиксированные к передней поверхности ДМ. Выявленные изменения свидетельствуют о повреждении задней стромы реципиента при десцеметорексисе, что может быть причиной неполного прилегания эндотелиального трансплантата. Полная адаптация трансплантата при повторной ЭК (DSAEK) в этом клиническом наблюдении, вероятно, обусловлена тем, что тонкий слой стромы в составе трансплантата обеспечивает высокую степень его адгезии к задней поверхности роговицы реципиента. Проведение DSAEK показано в качестве рекератопластики при стойком неприлегании эндотелиального трансплантата после DMEK.

In an aphakic eye with corneal edema, performing Descemet\'s stripping automated endothelial keratoplasty (DSAEK) combined with implantation of intraocular lens can be a challenge. This case report describes a surgical technique for postsurgical aphakia with endothelial decompensation in a 42-year-old female with Marfan syndrome and subluxated lens. This technique comprised implanting DSAEK with fibrin glue-assisted sutureless posterior chamber intraocular lens. The donor lenticels were formed on a 60-kHz femtosecond laser platform (IntraLase®). Two partial-thickness scleral flaps and sclerotomies were created, and then, the Descemet\'s membrane was scored and stripped. A posterior chamber intraocular lens was implanted, and its haptics was pulled out through the sclerotomies and tucked beneath the flaps. The flaps were then apposed with fibrin glue. The donor lenticule was introduced to the anterior chamber and unfolded. Air tamponade was used to stabilize and center it. This technique significantly improved the uncorrected and best-corrected visual acuities of the patient, and no donor dislocations were reported. This case corroborates the findings of few similar cases that have found combined use of glued intraocular lens with DSAEK to be beneficial in such cases.