July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Descemet Membrane Endothelial Keratoplasty with small grafts (mini-DMEK) for the treatment of focal defects in Descemet's membrane
Author Affiliations & Notes
  • Björn Bachmann
    Department of Ophthalmology, University of Cologne, Cologne, Germany
  • Alexaner Händel
    Department of Ophthalmology, University of Cologne, Cologne, Germany
  • Sebastian E Siebelmann
    Department of Ophthalmology, University of Cologne, Cologne, Germany
  • Mario Matthaei
    Department of Ophthalmology, University of Cologne, Cologne, Germany
  • Claus Cursiefen
    Department of Ophthalmology, University of Cologne, Cologne, Germany
  • Footnotes
    Commercial Relationships   Björn Bachmann, None; Alexaner Händel, None; Sebastian Siebelmann, None; Mario Matthaei, None; Claus Cursiefen, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 6287. doi:
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      Björn Bachmann, Alexaner Händel, Sebastian E Siebelmann, Mario Matthaei, Claus Cursiefen; Descemet Membrane Endothelial Keratoplasty with small grafts (mini-DMEK) for the treatment of focal defects in Descemet's membrane. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6287.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Descemet Membrane Endothelial Keratoplasty (DMEK) has evolved into a standard procedure for patients with corneal endothelial diseases. Recent reports suggest that DMEK can also improve corneal edema in patients with focal defects in Descemet’s membrane (DM) as in corneal hydrops ocurring in patients with keratoconus.

Methods : This is a retrospective analysis of consecutive patients after DMEK with small grafts (mini-DMEK) for the treatment of defects of DM. The gap in DM was sealed with a small DMEK graft whose diameter was adapted to the actual size of the wound in DM. Anterior segment OCT scans taken before and after surgery were used for morphometric analysis of the corneal edema. Snellen uncorrected visual acuity (UCVA) results were converted to logarithm of the Minimum Angle of Resolution (logMAR).

Results : 4 out of 6 Mini-DMEKs were performed in patients with acute corneal hydrops in keratoconus. One mini-DMEK was performed in a patient with a large central tear after DALK and one Mini-DMEK was performed in a patient with Haab’s striae in primary congenital glaucoma. Incomplete graft attachment necessitated one re-Mini-DMEK in a patient with acute keratoconus. Intraoperatively, unfolding and positioning of small grafts turned out to be more complex than in DMEK with grafts of normal size (> 7 mm). As confirmed clinically and by OCT scans after successful mini-DMEK corneal thickness and corneal edema decreased very fast in all patients. In all three patients with corneal hydrops there was a rapid increase in uncorrected visual acuity from logMAR 1.66 (±0.46) before mini-DMEK to logMAR 1.2 (±0.3) within 6-8 weeks after surgery.

Conclusions : Mini-DMEK is a viable treatment option for patients with ruptures or breaks of DM of different origin. Future analysis are needed for better identification of patients with defects of DM who might benefit from Mini-DMEK.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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