gms | German Medical Science

32. Kongress der Deutschsprachigen Gesellschaft für Intraokularlinsen-Implantation, Interventionelle und Refraktive Chirurgie (DGII)

Deutschsprachige Gesellschaft für Intraokularlinsen-Implantation, Interventionelle und Refraktive Chirurgie (DGII)

15.02. - 17.02.2018, Dresden

Keynote lecture: Histopathology of DMEK transplants – what we have learned

Keynote Lecture: Histopathologie von DMEK Transplantaten: Was wir gelernt haben

Meeting Abstract

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  • Gerrit R. J. Melles - Rotterdam/NL

Deutschsprachige Gesellschaft für Intraokularlinsen-Implantation, Interventionelle und Refraktive Chirurgie. 32. Kongress der Deutschsprachigen Gesellschaft für Intraokularlinsen-Implantation, Interventionelle und Refraktive Chirurgie (DGII). Dresden, 15.-17.02.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. Doc18dgii057

doi: 10.3205/18dgii057, urn:nbn:de:0183-18dgii0574

Veröffentlicht: 22. Februar 2018

© 2018 Melles.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Purpose: To describe the histologic features of post mortem eyes after Descemet membrane (DM) endothelial keratoplasty (DMEK) and their potential clinical implications.

Design: Histopathology study.

Participants: Eleven post mortem DMEK corneas of eight patients, operated for Fuchs endothelial dystrophy (FED), with an average postoperative time of 3.5 (±1.9) years (range 7 months to 6 years).

Methods: Eleven corneas transplanted with a DMEK graft were procured after death and processed for light microscopy evaluation.

Main outcome measures: Histological findings at the donor-to-host interface and at the host edge.

Results: Of the eleven corneas available for analysis, nine showed a 'normal' anatomy in the corneal center, i.e. the donor-to-host interface resembled that of a virgin eye. One eye also had an anatomically 'normal' periphery, but the remaining ten showed specific abnormalities in the periphery. Nine demonstrated overlapping of the DMEK graft onto the host edge of the descemetorhexis (and in six of these, the overlapping tissue showed a contracted inward fold at its peripheral edge with scar tissue); one eye showed a dense, acellular scar overlying a portion of the DMEK graft that had clinically shown a detachment followed by spontaneously adherence; three eyes showed subtle graft folds with scar tissue anteriorly; and in two eyes (of the same patient), the anterior banded layer of the host DM was still in-situ across the cornea (both of these eyes had required re-bubbling); and two eyes showed host DM remnants within the corneo-limbal tunnel incision that may have interfered with incisional wound healing.

Conclusion: Incomplete host DM removal may relate to postoperative DMEK graft detachment and wound instability. Graft detachments may re-attach with interface scarring. Re-bubbling procedures may be performed within 4-6 weeks, before scarring of detached graft portions occurs. Subtle DMEK graft folds may explain subjective complaints of monocular diplopia.