Descemet's membrane endothelial keratoplasty under failed penetrating keratoplasty without host descemetorhexis for the management of secondary graft failure

Session Details

Session Title: Presented Poster Session: Surgical Cornea

Venue: Poster Village: Pod 2

First Author: : J.Alio del Barrio SPAIN

Co Author(s): :    M. Bhogal   A. Montesel   V. Ho                 

Abstract Details

Purpose:

Some recent publications suggest the feasibility of performing endothelial keratoplasty (EK) without stripping the host descemet membrane (DM) and endothelium as far as they are anatomically intact without associated scarring or irregularities. EK surgery has become popular to rescue previous failed penetrating grafts (PK) due to the high postoperative complications rate of repeat PK. Moreover, DM-stripping in such cases can be challenging, and threats the donor-host junction integrity and new EK adherence. Our purpose is to evaluate the safety and efficacy of the treatment of penetrating keratoplasty secondary failure by DMEK surgery performed without host descemetorrhexis.

Setting:

Vissum Innovation and Universidad Miguel Hernández, Alicante, Spain. Guys & St Thomas’ Hospital, London, UK.

Methods:

Retrospective analysis of data collected on consecutive patients that underwent non host DM-stripping DMEK surgery under a previously failed PK. Routine DMEK surgery without host DM-endothelium removal was performed. DMEK graft diameter was either matched or 0.25-0.5mm undersized in relation to the PK diameter in order to avoid the DMEK graft being positioned under the donor-host posterior corneal surface interface and step. Eight patients were identified and included in the study. 6-months postoperative data is presented. Primary outcome measure was safety and anatomical success.

Results:

No intraoperative complications were registered. Postoperatively, one case developed a PK host-donor junction dehiscence in relation to a previous early suture removal, requiring PK re-suturing and DMEK rebubbling. Only one additional case required one DMEK re-bubbling. No primary graft failure was detected and all cases achieved a full PK transparency within 2 weeks. Corrected distance visual acuity improved from a median of counting fingers (CF) (CF-0.2) to 0.57(0.05-0.7) 6 months postop. Median central corneal thickness improved from 650.5 (497-897) to 464 (372-597)µm. Median endothelial cell density 6 months postop was 1080 (581-2043)cells/mm2. All patients associated extensive preoperative ocular co-morbidity.

Conclusions:

DMEK is able rehabilitate those PK grafts that suffered secondary failure and subsequently restore patient’s visual function, avoiding all well-known drawbacks of repeat penetrating grafts. This study shows the feasibility of performing this endothelial keratoplasty without removing the host DM-endothelium, what simplifies the surgical procedure and avoids the potential intraoperative complications associated with this surgical step, while keeping good levels of safety and efficacy and with a low rate of graft re-bubbling.

Financial Disclosure:

None