Clinical outcomes of Descemet's membrane endothelial keratoplasty in eyes with a glaucoma drainage device

Session Details

Session Title: Cornea Surgical: Lamellar Corneal Grafts

Session Date/Time: Tuesday 17/09/2019 | 08:30-10:30

Paper Time: 08:42

Venue: Free Paper Forum: Podium 3

First Author: : D.Dragnea ROMANIA

Co Author(s): :    R. Birbal   I. Dapena   L. Han   J. Parker   S. Oellerich   G. Melles              

Abstract Details

Purpose:

To evaluate the feasibility and clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with a glaucoma drainage device (GDD).

Setting:

Netherlands Institute for Innovative Ocular Surgery / Tertiary referral center.

Methods:

In this retrospective, interventional case series the clinical outcomes of 23 DMEK procedures for bullous keratopathy (52%), failed previous transplant (39%) or Fuchs endothelial corneal dystrophy (9%) in 20 eyes (19 patients) with a GDD were analyzed at two tertiary referral centers. Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD), postoperative complications, and graft survival. Mean length of postoperative follow-up was 19 (±17) months.

Results:

At 1 year postoperatively, survival analysis showed an 89% cumulative graft success rate and BCVA (n=15) improved by ≥2 Snellen lines in 11 eyes (73%) and remained stable in 4 eyes (27%). Donor ECD decreased by 37% (n=14) and 71% (n=11) at 1 and 12 months postoperative, respectively. Main postoperative complications up to 2 years postoperatively comprised graft detachment requiring re-bubbling in 5 eyes (22%), allograft rejection successfully reversed with topical steroids in 2 eyes (9%), secondary graft failure in 2 eyes (9%) and cataract in one of 3 phakic eyes (33%). Re-keratoplasty was required in 2 eyes (9%).

Conclusions:

With specific surgical modifications, DMEK provided acceptable clinical outcomes when taking the complexity of these eyes into account. However, presence of a GDD may reduce graft survival times and may pose a risk for more frequent re-grafting.

Financial Disclosure:

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