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Background: Small Descemet membrane detachments after cataract surgery are relatively common and most cases do not require any secondary surgical intervention and can be treated conservatively. However, in case of advanced Descemet membrane detachment (DMD), it needs to be recognized and treated appropriately. The advent of anterior segment imaging using optical coherence tomography (OCT) technology has made diagnosing pathologies of the anterior segment accurate and time efficient and has proven as an invaluable tool to guide decision making.Case presentation: A 71-year-old patient presented after complicated cataract surgery with decreased visual acuity and cloudy vision. On examination, best corrected visual acuity was 1.5 logMAR. A high-resolution swept-source OCT (Anterion, Heidelberg Engineering, Heidelberg, Germany) was used to better evaluate and visualize the extent of DMD. An anterior chamber gas bubble was injected to reattach the Descemet membrane (DM) to the corneal stroma. The success of the surgery was visualized using the high-resolution swept-source OCT. This revealed a completely attached Descemet membrane.Conclusions: Clinically, it can be difficult to distinguish the etiology of epithelial and stromal edema post cataract surgery. This case demonstrated the clinical usefulness using high resolution swept source imaging to guide clinical decision making in evaluating timing and treatment success of pneumodescemetopexy after complicated cataract surgery.

Purpose: High-order aberrations (HOAs) are known to be increased in corneas with Fuchs endothelial dystrophy (FECD) and are associated with visual impairment. This case series aimed to analyze whether tomographic changes in FECD affect the HOA in the early period of the disease., Methods: In this retrospective single-center case series, 144 eyes of 85 patients were included, of which 78 eyes of 47 patients with FECD with slit-lamp biomicroscopically visible guttae but no visible corneal edema served as the study-cohort. According to Sun et al, included eyes were divided into 2 groups: group 0 (n = 28; no subclinical corneal edema) and group 1 (n = 50; subclinical corneal edema). A total of 66 healthy eyes of 38 patients served as control group. Mean values and standard deviations were calculated for the root mean square (RMS), coma, trefoil and spherical aberrations (SA) of the cornea (C), the anterior surface (CF), and the posterior surface (CB)., Results: Statistically significant differences (P < 0.001) in the RMS HOA (group 0: 0.209 ± 0.044 μm, group 1: 0.372 ± 0.122 μm) and in coma (group 0: 0.082 ± 0.054 μm, group 1: 0.214 ± 0.101 μm) and SA (group 0: -0.130 ± 0.038 μm, group 1: -0.176 ± 0.074 μm) of the CB were found in eyes in group 1 versus those in group 0. There were no statistically significant differences in HOA between the control group and eyes in group 0., Conclusions: FECD eyes with subclinical corneal edema demonstrated significant increase in RMS, coma, and SA of the CB. Tomographic analysis, therefore, helps in visual impairment assessment, disease progression, and decision-making for early endothelial keratoplasty in patients with FECD., Competing Interests: L. Blöck reports reimbursement of travel expenses from Oculus Optikgeräte, Wetzlar, Germany. H.-S. Son, M. Friedrich, and M. K. Köppe declare that they have no conflict of interest. V. A. Augustin reports research grant from Kowa Co., Ltd. G. Auffarth reports grants, personal fees, nonfinancial support, and consulting fees from Johnson&Johnson and Alcon, grants, personal fees, and nonfinancial support from Carl Zeiss Meditec, Hoya, Kowa, Oculentis/Teleon, Rayner, Sifi, Ursapharm, grants and personal fees from Biotech, Oculus, EyeYon grants from, Contamac outside the submitted work., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Keratoconus is a bilateral, yet asymmetric disease. In rare cases, the second eye may show no signs of tomographic changes. The purpose of this study was to analyze the biomechanical characteristics in tomographically regular keratoconus fellow eyes., Materials and Methods: This retrospective, consecutive case series analyzed 916 eyes of 458 patients who presented to our keratoconus clinic between November 2020 and October 2022. Primary outcome measures included best-corrected visual acuity (BCVA), tomographic Scheimpflug analysis using Pentacam AXL (Oculus, Wetzlar, Germany), and biomechanical assessment using Corvis ST (Oculus, Wetzlar, Germany). Tomographic changes were assessed via analysis of the anterior and posterior curvature, K-max, thinnest corneal thickness (TCT), the Belin/Ambrosio Deviation Display (BAD-D), and the ABCD-Grading. Biomechanical changes were analyzed using Corvis Biomechanical Index (CBI) and Tomographic Biomechanical Index (TBI)., Results: Of 916 eyes, 34 tomographically regular fellow eyes (7.4%) were identified and included in the analysis. Overall, the mean BCVA was - 0.02 ± 0.13 logMAR. Tomographic analysis showed mean K-max of 43.87 ± 1.21 D, mean TCT of 532 ± 23 µm, and mean BAD-D of 1.02 ± 0.43. Biomechanical analysis demonstrated mean CBI of 0.28 ± 0.26 and mean TBI of 0.34 ± 0.30. While normal CBI-values were observed in 16 (47%) of 34 eyes, only 13 eyes (38%) showed a regular TBI and only 7 eyes (21%) showed regular TBI and CBI. The sensitivity of CBI and TBI to detect a tomographically normal keratoconus fellow eye was 53% and 62%, respectively., Conclusion: A highly asymmetric corneal ectasia with regular tomographic finding in a fellow eye is rare among keratoconus patients. In such cases, a biomechanical analysis may be useful in detecting early signs of corneal ectasia. In our analysis, the TBI showed high sensitivity for detecting a biomechanical abnormality in tomographically regular fellow eyes., Competing Interests: R. K. berichtet über Forschungszuschüsse und Vortragshonorare von Alcon, Hoya, PhysIOL, Rayner, 1stQ und Johnson & Johnson, Vortragshonorare von Kowa, Ophtec, Teleon, Santen, Acufocus, Bauch & Lomb und Reisestipendien von Alcon, Teleon, Johnson & Johnson, Rayner und 1stQ. G. U. A. berichtet über Forschungsstipendien, Reisestipendien und Vortragshonorare von Alcon, Hoya, Kowa, SIFI, Forschungsstipendien und Vortragshonorare von Johnson & Johnson und Santen sowie Forschungsstipendien von Zeiss, PhysIOL und Acufocus. T. M. Y. erhält Vortragshonorare von Alcon. Alle anderen Autoren geben keine Interessenkonflikte an./R. K. reports research grants and lecture fees from Alcon, Hoya, PhysIOL, Rayner, 1stQ and Johnson & Johnson, lecture fees from Kowa, Ophtec, Teleon, Santen, Acufocus, Bauch & Lomb and travel grants from Alcon, Teleon, Johnson & Johnson, Rayner and 1stQ. G. U. A. reports research grants, travel grants and lecture fees from Alcon, Hoya, Kowa, SIFI, research grants and lecture fees from Johnson & Johnson and Santen and research grants from Zeiss, PhysIOL and Acufocus. T. M. Y. receives lecture fees from Alcon. All other authors indicate no conflicts of interest., (Thieme. All rights reserved.)