• Saki Sakakura, Risa Yamazaki, Yuichi Uchino, Kazuno Negishi, and Shigeto Shimmura.
• Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
• Medicine (Baltimore). 2024 Sep 27; 103 (39): e39767e39767.

RationalePatients with atopic dermatitis undergoing penetrating keratoplasty (PKP) face a high risk of postoperative complications. Endothelial keratoplasty may be a safer alternative for such patients, including those with abnormal anterior chamber anatomy.Patient Concerns3 male patients, aged 33 to 44, presented with blurred vision at Keio University Hospital.DiagnosisBullous keratopathy was diagnosed through slit-lamp examination and specular microscopy. Two patients had well-controlled systemic atopic dermatitis, while 1 had blepharitis associated with atopic dermatitis. Two patients had peripheral anterior synechia, and 2 had undergone glaucoma surgery before keratoplasty.InterventionsNon-Descemet stripping endothelial keratoplasty (nDSAEK) was performed by a single surgeon.OutcomesThe best-corrected visual acuity ranged from 0.7 to 1.5 logMAR before surgery and from 0.2 to 2.3 logMAR after surgery. One year post-surgery, the graft remained clear in 2 cases; however, in the case of repeated glaucoma surgeries after nDSAEK, the graft became edematous. Corneal endothelial cell density was 1586 and 1988 cells/mm² in 2 cases and undetectable in the failed case. The follow-up period ranged from 2.5 to 9 years.LessonsDespite the presence of peripheral anterior synechia or prior glaucoma surgery, some patients experienced a favorable long-term postoperative course following nDSAEK. This procedure may offer a safer alternative for treating patients with atopic dermatitis who have ocular complications that present a high risk for PKP.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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