Back to Freepaper Session

Potential causes of incomplete visual rehabilitation after Descemet"s membrane endothelial keratoplasty (DMEK)

Session Details

Session Title: Cornea surgical I

Session Date/Time: Tuesday 08/10/2013 | 08:00-10:30

Paper Time: 09:36

Venue: Forum (Ground Floor)

First Author: : I.Dapena THE NETHERLANDS

Co Author(s): :    R. Yeh   L. Baydoun   J. Cabrerizo   K. van Dijk   L. Ham   G.

Abstract Details

Purpose:

To determine the various causes of unexpected incomplete visual rehabilitation after Descemet membrane endothelial keratoplasty (DMEK).

Setting:

Retrospective cohort study at the Netherlands Institute for Innovative Ocular Surgery.

Methods:

From a larger group of 400 consecutive DMEK surgeries, the last 200 eyes were retrospectively reviewed for visual discomfort despite a best corrected visual acuity (BCVA) of ?20/25 (?0.8) or unexpected subnormal BCVA (?20/28; ?0.7) at 6 months after DMEK. Biomicroscopy, fundoscopy, Pentacam imaging, non-contact specular microscopy, anterior segment optical coherence tomography (OCT), and surgical videos were used to determine the causes of incomplete visual rehabilitation.

Results:

A total of 69 eyes (38%) out of 178 eyes that were included in the analysis, presented with incomplete visual rehabilitation after DMEK, further categorized as ‘primarily patient-related’ in 40/69 (58%), ‘primarily graft-related’ in 21/69 (30%), and a combination of ‘patient-graft related’ in 8/69 (12%) of cases. Unrecognized pre-existing ocular pathology and/or posterior segment disease in 19/69 eyes (28%), clinically significant corneal irregularities and/or central corneal scarring often secondary to long-standing preoperative corneal edema in 14/69 eyes (20%) or (partial) graft detachment in 20/69 eyes (29%), were the main causes of unexpected incomplete visual rehabilitation after DMEK.

Conclusions:

In contrast to earlier endothelial keratoplasty techniques, that may frequently be associated with undefined transplant-related subnormal visual outcomes, incomplete visual rehabilitation after DMEK may virtually always be explained by concomitant ocular pathology or evident graft failure.

Financial Interest:

... receives consulting fees, retainer, or contract payments from a competing company