Posters

Histopathology of Descemet's membrane endothelial keratoplasty graft remnants, folds and detachments

Poster Details

First Author: J. Parker THE NETHERLANDS

Co Author(s): T. Muller   I. Lavy   R. Verdijk   L. Baydoun   G. Melles        

Abstract Details

Purpose:

To describe the histologic features of postmortem eyes after Descemet membrane (DM) endothelial keratoplasty (DMEK) and their potential clinical implications.

Setting:

Netherlands Institute for Innovative Ocular Surgery / Tertiary referral center.

Methods:

Eleven postmortem DMEK corneas of eight patients, operated on for Fuchs endothelial dystrophy (FED), with an average postoperative time of 4 (±1.9) years (range 7 months to 6.5 years), were procured after death and processed for light microscopy evaluation.

Results:

9 corneas showed a 'normal' central anatomy, i.e. the donor-to-host interface resembled that of a virgin eye. 1 cornea also showed a 'normal' periphery. 10 corneas showed peripheral abnormalities: in 9 corneas, the DMEK-graft overlapped the descemetorhexis edge; 1 showed scarring overlying a portion of the graft with previous detachment followed by spontaneously adherence; 3 eyes showed graft folds with scarring; in 2 eyes, the anterior banded layer of the host-DM was still in-situ across the cornea (both eyes had required re-bubbling); and 2 eyes showed host-DM remnants within the corneal incision that may have interfered with wound healing.

Conclusions:

: Incomplete host DM removal may relate to postoperative DMEK graft detachment and wound instability. Graft detachments may re-attach with interface scarring. Re-bubbling procedures may be performed within 4-6 weeks, before scarring of detached graft portions occurs. Subtle DMEK graft folds may explain subjective complaints of monocular diplopia.

Financial Disclosure:

None