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Identifying causes for poor visual outcome after DSEK/DSAEK following secondary DMEK in the same eye

Session Details

Session Title: Cornea surgical I

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

Paper Time: 10:00

Venue: Forum (Ground Floor)

First Author: : M.Dirisamer AUSTRIA

Co Author(s): :    J. Parker   M. Naveiras   V. Liarakos   L. Ham   K. van Dijk   G.

Abstract Details

Purpose:

To identify causes of reduced visual acuity after Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK), and to determine if such eyes can be successfully ‘repaired’ with a secondary Descemet membrane endothelial keratoplasty (DMEK).

Setting:

Non-randomized, prospective study, at a tertiary referral center. Netherlands Institute for Innovative Ocular Surgery, Rotterdam.

Methods:

Twelve eyes of twelve patients, that underwent secondary DMEK to manage poor visual outcome after initial DSEK/DSAEK, were evaluated with biomicroscopy, Pentacam imaging, and specular and confocal microscopy, before and at 1, 3 and 6 months after DMEK.

Results:

Four causes of reduced optical quality of the transplanted host cornea could be identified in DSEK/DSAEK: five eyes (42%) showed large host-Descemet remnants within the visual axis during surgery; six eyes (50%) irregular graft thickness; six eyes subtle ‘stromal waves’; and nine eyes (75%) high reflectivity at the donor-to-host interface. After DMEK graft replacement, all corneas cleared and achieved a best corrected visual acuity of ?20/25 (?0.8), except for one with a partial Descemet graft detachment. Pachymetry values decreased from 670 (±112) µm before, to 517 (±57) µm after secondary DMEK. Higher order aberrations (Coma and Trefoil) at the posterior surface tended to be lower (P=0.07) in DMEK grafts than in DSEK/DSAEK grafts.

Conclusions:

. Host-Descemet remnants at the donor-to-host interface, interface reflectivity, graft thickness irregularity and donor stromal contraction, may contribute to poor visual outcome after DSEK/DSAEK, without causing permanent host corneal damage, since in most cases complete visual recovery could be achieved by performing a secondary DMEK.

Financial Interest:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented