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Victor A Augustin, Julia M Weller, Friedrich E Kruse, Theofilos Tourtas; Delayed corneal clearance after uneventful Descemet Membrane endothelial keratoplasty. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6285.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze the incidence and outcomes of eyes with delayed corneal clearance after uneventful Descemet membrane endothelial keratoplasty (DMEK).
In this retrospective, single-center, consecutive case series the clinical records of 1538 eyes who underwent DMEK for Fuchs endothelial corneal dystrophy (FECD) were reviewed. 44 eyes fulfilled the following inclusion criteria and were included in the study: I. Significant corneal edema over the entire cornea at day 14 after surgery without any tendency of corneal clearance, II. completely attached graft, III. uneventful surgery, IV. normal intraocular pressure. Corneal grafts were either organ cultured in DMEM (n=7, 16%) or hypothermic in Optisol (n=37, 84%). Mean donor endothelial cell density (ECD) was 2440 ± 175 cells/mm2, mean storage duration was 7.6 ± 3.5 days and mean death-to-preservation time was 11 ± 5 hours. Patients were examined 3, 12 and 24 months after surgery. Main outcome measures were best-corrected visual acuity (BCVA), central corneal thickness (CCT), ECD, and incidence of repeat DMEK. The study was approved by the Institutional Review Board of the University of Erlangen as a retrospective review of data.
Out of 1538 DMEK surgeries performed for FECD 44 eyes (2.9%) showed no tendency of corneal clearance at day 14 after surgery. Mean preoperative BCVA was 0.47 ± 0.21 (logMAR) and mean CCT was 611 ± 53 µm. Mean graft unfolding time during surgery was 2.4 ± 1.4 minutes. 14 days after surgery mean CCT was 952 ± 230 µm and mean BCVA was 1.35 ± 0.39 (logMAR). Three months after surgery 29/44 (66%) eyes cleared without any additional intervention and remained clear until the last follow-up. 12/44 (27%) eyes failed to clear and were scheduled for repeat DMEK. 3/44 (7%) eyes showed a trend of corneal clearance over several weeks with decrease in CCT resulting though in late failure after 9-12 months. Overall regrafting incidence was 34%.
Late corneal clearance after uneventful DMEK is rare. Eyes with significant corneal edema at day 14 after surgery are at high risk for primary graft failure. Nevertheless, two-thirds of our cases cleared within the first 3 months. In these cases BCVA, CCT and ECD remained stable until the last follow-up indicating no increased risk for secondary graft failure. These data are in favour of waiting 3 months before exchanging the graft by repeat DMEK surgery.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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