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Abstract #59081 Published in IGR 16-3

Repeat Descemet Membrane Endothelial Keratoplasty after Complicated Primary Descemet Membrane Endothelial Keratoplasty

Baydoun L; van Dijk K; Dapena I; Musa FU; Liarakos VS; Ham L; Melles GR
Ophthalmology 2015; 122: 8-16

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PURPOSE: To describe the clinical outcome and complications of repeat Descemet membrane endothelial keratoplasty (re-DMEK). DESIGN: Retrospective case series study at a tertiary referral center. PARTICIPANTS: From a series of 550 consecutive DMEK surgeries with ≥6 months follow-up, 17 eyes underwent re-DMEK for graft detachment after initial DMEK (n = 14) and/or endothelial graft failure (n = 3). The outcomes were compared with an age-matched control group of uncomplicated primary DMEK surgeries. METHODS: The re-DMEK eyes were evaluated for best-corrected visual acuity (BCVA), densitometry, endothelial cell density (ECD), pachymetry, and intraoperative and postoperative complications. MAIN OUTCOME MEASURES: Feasibility and clinical outcome of re-DMEK. RESULTS: In all eyes, re-DMEK was uneventful. At 12 months, 12 of 14 eyes (86%) achieved a BCVA of ≥20/40 (≥0.5); 8 of 14 eyes (57%) achieved ≥20/25 (≥0.8), 3 of 14 eyes (21%) achieved ≥20/20 (≥1.0), and 1 eye (7%) achieved 20/17 (1.2); 5 eyes were fitted with a contact lens. Average donor ECD decreased from 2580±173 cells/mm(2) before to 1390±466 cells/mm(2) at 6 months after surgery, and pachymetry from 703±126 μm to 515±39 μm, respectively. 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), secondary graft failure (n = 2), graft detachment requiring rebubbling (n = 1), secondary glaucoma (n = 2), cataract (n = 1), and corneal ulcer (n = 1). One eye received tertiary DMEK. CONCLUSIONS: In the management of persistent graft detachment and graft failure after primary DMEK, re-DMEK proved a feasible procedure. 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 recur, suggesting that intrinsic properties of the host eye play a role in graft adherence and graft failure.

Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands.

Full article

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Classification:

9.4.11.4 Glaucomas associated with corneal surgery (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.11 Glaucomas following intraocular surgery)
2.2 Cornea (Part of: 2 Anatomical structures in glaucoma)

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