Session Title: Cornea
Session Date/Time: Sunday 05/02/2012 | 08:30-11:00
Paper Time: 09:23
Venue: Hall 1
First Author: : V.Liarakos GREECE
Co Author(s): : M. DIRISAMER K. VAN DIJK I. DAPENA L. HAM G. MELLES
Purpose:
To describe the prevention and management of various types of graft detachment after Descemet’s membrane endothelial keratoplasty (DMEK).
Setting:
Non–randomized, prospective clinical study, at a tertiary referral center. Netherlands Institute for Innovative Ocular Surgery, Rotterdam.
Methods:
In 150 consecutive DMEK surgeries, the incidence and type of graft detachment were studied, at 1, 3, 6, 9, 12, and 24 months after surgery. Four groups of detachments were identified: a partial detachment of one third or less of the graft surface area (n=16; Group I); a partial detachment of more than one third of the graft surface area (n=8; Group II); a graft positioned upside down (n=4; Group III); and a free-floating Descemet-roll in the host anterior chamber (n=8; Group IV). RESULTS Partial or complete graft detachment was found in 36 cases (24%), of which 18 (12%) were clinically significant. All 24 eyes with a partial detachment (Groups I and II) showed spontaneous corneal clearance, and all but six of these eyes (75%) reached a visual acuity of 20/40 or better (≥0.5). A reversed clearance pattern and interface spikes were observed in eyes with the graft positioned upside-down (Group III). Eyes with a free-floating graft (Group IV) showed persistent corneal edema. Detachments were associated with inward folds (12 eyes [33%]), insufficient air-bubble support (7 eyes [19%]), upside-down graft positioning (4 eyes [11%]), use of plastic materials (2 eyes [6%]) irido-graft synechiae (1 eye [3%]), poor endothelial morphology (1 eye [3%]) and stromal irregularity underneath the main incision (1 eye [3%]); 14 (56%) of the partial detachments were localized inferiorly.
Conclusions:
Awaiting spontaneous clearance may be advocated in eyes with a partial detachment. Minor adjustments in surgical protocol as well as careful patient selection may further reduce the incidence of graft detachment after DMEK to 4% or less.
Financial Disclosure:
... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented
