Repeat Descemet's membrane endothelial keratoplasty (DMEK) for unsuccessful previous DMEK

Session Details

Session Title: Cornea Surgical I

Session Date/Time: Monday 15/09/2014 | 08:00-10:30

Paper Time: 09:39

Venue: Boulevard B

First Author: : L.Baydoun THE NETHERLANDS

Co Author(s): :    K. van Dijk   I. Dapena   F. Musa   V. Liarakos   L. Ham   G. Melles

Abstract Details

Purpose:

To describe the feasibility, clinical outcome and complications of re-DMEK.

Setting:

Netherlands Institute for Innovative Ocular Surgery / Tertiary referral center.

Methods:

From a series of 550 consecutive DMEK surgeries with at least six months follow-up, 17 eyes had re-DMEK for graft detachment (n=14) and/or endothelial graft failure (n=3) after initial DMEK. Re-DMEK eyes were evaluated for best corrected visual acuity (BCVA), densitometry, endothelial cell density (ECD), pachymetry, and intra- and postoperative complications. The outcomes were compared to an age-matched control group of uncomplicated primary DMEK surgeries.

Results:

Re-DMEK was uneventful in all eyes. At 12 months, 12/14 (86%) reached ≥20/40 (≥0.5), 8/14 (57%) reached ≥20/25 (≥0.8), 3/14 (21%) reached ≥20/20 (≥1.0) and one eye reached 20/17 (1.2); five eyes had been fitted with a contact lens. Average donor ECD decreased from 2580 (±173) cells/mm2 before, to 1390 (±466) cells/mm2 at six months after surgery, and pachymetry from 703 (±126) to 515 (±39) µm. No difference in densitometry could be detected between re-DMEK and control eyes (P=0.99). Complications after re-DMEK included primary graft failure (n=1) and secondary graft failure (n=2) requiring tertiary DMEK, graft detachment requiring re-bubbling (n=1), secondary glaucoma (n=2), cataract (n=1) and corneal ulcer (n=1).

Conclusions:

Re-DMEK proved a feasible procedure in the management of persistent graft detachment and graft failure after primary DMEK. Acceptable BCVA may be achieved albeit lower than after DMEK in virgin eyes, and some cases may benefit from contact lens fitting. Complications after re-DMEK may be better anticipated than after primary DMEK, because graft detachment and graft failure tended to re-occur, suggesting that intrinsic properties of the host eye play a role in graft adherence and graft failure.

Financial Interest:

One or more of the authors... receives nonNONEmonetary benefits from a company producing, developing or supplying the product or procedure presented.