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Ingo Schmack, Bishr Agha, Mehdi Shajari, Monika Lawatsch, Thomas Kohnen; Feasibility and clinical outcome of secondary Descemet Membrane Endothelial Keratoplasty (DMEK) after failed primary DMEK. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1307. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the feasibility and clinical outcome of secondary Descemet membrane endothelial keratoplasty (DMEK) for graft failure after primary DMEK surgery.
Retrospective, comparative, interventional case series including 8 with secondary DMEK for corneal decompensation after previous DMEK failure (study group: female, 2; male, 6; mean age, 76.6±3.3 years) and 8 age-matched patients (control group: female, 4; male, 4; mean age, 75.6±2.4 years) with successful primary DMEK, only. Patients were evaluated before and at 1 week, 1 and 3 months after DMEK surgery. Indications for primary DMEK were FECD (n=7 vs. n=5) and bullous keratopathy (n=1 vs. n=3). Main outcome measures included preoperative and postoperative corrected distance visual acuity (CDVA), central corneal thickness (CCT), endothelial cell density (ECD), and rebubbling rate.
Preoperative CDVA (logMAR) was comparable between both groups. It improved after 3 months from 2.45 ± 0.81 to .94 ± .32 (study group, p <.05) and from 2.26 ± .79 to .55 ± .31 (control group, p <.05) (p> .05). Overall, CDVA was slightly better in the control group compared to the study group. However, intergroup comparison did not show statistical significance. During follow up, CCT and ECD decreased in both groups (p> .05). The rebubbling rate was 25% (2/8, study group) versus 37.5% (3/8, control group).
Repeat DMEK demonstrates to be a safe and effective approach for visual rehabilitation of patients with corneal decompensation after failed previous DMEK procedure. The clinical outcome of patients with secondary DMEK may be similar to primary DMEK.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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