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Michaela Moelle, Björn O. Bachmann, Ursula Schlötzer-Schrehardt, Friedrich E. Kruse; Reasons For Failure Of Descemet`s Membrane Endothelial Keratoplasty (DMEK) And Results Of Repeat DMEK. Invest. Ophthalmol. Vis. Sci. 2012;53(14):62.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the reasons for failure of DMEK and to investigate the visual outcome in patients undergoing repeat DMEK after failed primary DMEK.
This retrospective case series involved the review of clinical records of 10 patients with failed primary DMEK surgery who underwent repeat DMEK. Best corrected visual acuity (BCVA) and endothelial cell density (ECD) were quantified before, at 1 month and at 3 months after transplantation. The primary graft obtained during the repeat DMEK surgery was examined by transmission electron microscopy in 7 cases.
Primary diagnoses were Fuchs endothelial dystrophy (n=9) and corneal endothelial decompensation after trabeculectomy (n=1). Electron microscopic examination of failed primary grafts showed inverted transplantation in one case, the presence of retrocorneal deposits of pseudoexfoliation material in another case, and abnormal collagen inclusions within the thickened Descemet’s membrane indicative of a pre-existing endothelial dysfunction in 3 cases. Only 2 of the explants revealed a regular ultrastructure and thickness. Following repeat DMEK, mean BCVA improved from 1.3 ± 0.6 (logMAR) preoperatively to 0.55 ± 0.3 after 4 weeks follow-up and to 0.46 ± 0.3 at 3 months follow-up. Improvement in BCVA was statistically significant at 4 weeks and at 3 months follow-up (p < 0.05). The mean ECD of the donor tissue (n = 10) was 2507 ± 229 cells/mm2 (range 2200 to 2920 cells/mm2). The mean ECD decreased to 1614 ± 266 cells/mm2 at 4 weeks and to 1644 ± 262 cells/mm2 at 3 months. This decrease was statistically significant (p < 0.05).
Repeat DMEK can be successfully performed in cases of failed DMEK without noticeable alteration of the host corneal stroma and improves visual outcome. In the majority of cases, causes of DMEK failure can be attributed to pre-existing corneal endothelial dysfunction and Descemet`s membrane pathology, and less often to surgical problems.
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