gms | German Medical Science

27th International Congress of German Ophthalmic Surgeons

15. to 17.05.2014, Nürnberg

Repeat Descemet membrane endothelial keratoplasty (DMEK) for unsuccessful previous DMEK (B)

Meeting Abstract

  • Lamis Baydoun - Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande
  • Korine van Dijk - Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande
  • Isabel Dapena - Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande
  • Vasilis Liarakos - Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande
  • Lisanne Ham - Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande
  • Gerrit Melles - Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande

27. Internationaler Kongress der Deutschen Ophthalmochirurgen. Nürnberg, 15.-17.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocWK 4.17

doi: 10.3205/14doc131, urn:nbn:de:0183-14doc1317

Published: May 5, 2014

© 2014 Baydoun et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Purpose: To describe the feasibility, clinical outcome and complications of re-DMEK.

Methods: From a series of 550 consecutive DMEK surgeries with at least six months follow-up, 17 eyes had re-DMEK for graft detachment (n=14) and/or endothelial graft failure (n=3) after initial DMEK. Re-DMEK eyes were evaluated for best corrected visual acuity (BCVA), densitometry, endothelial cell density (ECD), pachymetry, and intra- and postoperative complications. The outcomes were compared to an age-matched control group of uncomplicated primary DMEK surgeries.

Results: Re-DMEK was uneventful in all eyes. At 12 months, 12/14 (86%) reached ≥20/40 (≥0.5); 8/14 (57%) reached ≥20/25 (≥0.8), 3/14 (21%) reached ≥20/20 (≥1.0) and one eye reached 20/17 (1.2); five eyes had been fitted with a contact lens. Average donor ECD decreased from 2580 (±173) cells/mm2 before, to 1390 (±466) cells/mm2 at six months after surgery, and pachymetry from 703 (±126) to 515 (±39) µm. 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) and secondary graft failure (n=2) requiring tertiary DMEK, graft detachment requiring re-bubbling (n=1), secondary glaucoma (n=2), cataract (n=1) and corneal ulcer (n=1).

Conclusion: Re-DMEK proved a feasible procedure in the management of persistent graft detachment and graft failure after primary DMEK. 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 re-occur, suggesting that intrinsic properties of the host eye play a role in graft adherence and graft failure.