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Juliane Schlomberg, Theofilos Tourtas, Stephan Riss, Michaela Moelle, Kathrin Laaser, Björn Bachmann, Friedrich Kruse; Extent Of Removal Of Descement Membrane Determines Graft Adhesion In DMEK. Invest. Ophthalmol. Vis. Sci. 2012;53(14):61.
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Primary graft detachment is the major limitation of Descemet membrane endothelial keratoplasty (DMEK). Besides factors determined by the anatomy of Descemet’s membrane (DM) and the host stroma the nature of the interface (DM vs. denuded stroma) might have an influence on graft adhesion. Here we investigated whether the size of the descemetorhexis determines graft adhesion.
A retrospective analysis of 100 eyes that underwent DMEK by a single surgeon was performed. Based on intraoperative drawings, slit lamp examination and photographies we estimated the dimension of the overlapping zone between donor and graft DM as percentage of the circumference of the donor tissue. The amount of graft’s detachment was estimated as clock hours and the number of additional air injections necessary for complete graft adhesion was defined. Significant graft detachment was defined as an area greater or equal to 3 hours of circumference.
Based on the size of descemetorhexis 3 groups were found: 15 patients in which the graft and the patients DM overlapped completely (100%) (group 1), 21 patients in which no overlap was seen and in which the graft was separated from DM by a small gap (group 2) and 69 patients with variable overlap (group 3).Significant graft detachment appeared in 10 eyes of group 1 and 3 eyes of group 2. The area of peripheral detachment was significantly greater in group 1 than in group 2 (group 1 3.5 ± 1.0 clock hours, group 2 0.9 ± 0.3 clock hours, p=.002). Re-bubbling was performed in 3 eyes of group1 due to persistent major detachment (9.2 ± 1.3 clock hours), but was not necessary in group 2.
Our results suggest that complete removal of DM in the area of the graft allows better adhesion of the graft. Greater overlap is a risk factor leading to graft detachment. Thus patients with greater overlap have to be followed up more carefully.
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