Case Reports

Graft attachment with subsequent corneal clearance after inadvertent graft inversion during Descemet membrane endothelial keratoplasty

Case Report Details

First Author: G.Galante ITALY

Co Author(s):    G. Galante   C. Bovone   A. Yu   M. Busin           

Abstract Details

Purpose:

To report the clinical outcome of a Descemet membrane endothelial keratoplasty (DMEK) graft inadvertently implanted in an inverted (endothelium-up) orientation.

Setting:

Tertiary Care Referral Center (Ospedali Privati Forlì, Villa Igea)

Report of Case:

A 57-year old female presented with cataract and Fuchs endothelial corneal dystrophy with preoperative Snellen best spectacle-corrected visual acuity (BSCVA) of 20/100 (logMAR 0.7) underwent uneventful DMEK. On the first postoperative day, the graft was well-centered with peripheral partial graft detachment. One week after DMEK, the cornea failed to clear and the graft remained partially detached. Rebubbling with intracameral air was performed. At 1 month follow-up, the graft remained completely attached but was noted with an inverted orientation. No evidence of primary graft failure was noted and uncorrected visual acuity was Snellen 20/40. One year after surgery, visual acuity further improved to 20/20 with an endothelial cell count of 1226 cells/mm 2 .

Conclusion/Take Home Message:

Graft attachment and subsequent corneal clearance may occur despite an inverted graft orientation. Although primary graft failure has been attributed to inverted grafts, unknown biomechanical factors may allow corneal clearance despite inadvertent inversion of a DMEK graft.

Financial Disclosure:

None