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. 2019 Mar 25:13:553-559.
doi: 10.2147/OPTH.S194185. eCollection 2019.

Outcome of Descemet membrane endothelial keratoplasty for graft failure after Descemet stripping automated endothelial keratoplasty

Bishr Agha  1 , Mehdi Shajari  1 , Anna Slavik-Lencova  1 , Thomas Kohnen  1 , Ingo Schmack  1
Affiliations

Outcome of Descemet membrane endothelial keratoplasty for graft failure after Descemet stripping automated endothelial keratoplasty

Bishr Agha et al. Clin Ophthalmol. .

Abstract

Purpose: To investigate the efficacy and safety of Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following primary Descemet stripping automated endothelial keratoplasty (DSAEK).

Methods: This was a retrospective case series of 15 patients that underwent DMEK surgery for corneal decompensation after failed DSAEK. Main outcome parameter was corrected distance visual acuity (CDVA) after DMEK and DSAEK. Secondary outcome measures included central corneal thickness (CCT), endothelial cell density (ECD), rebubbling rate, and primary graft failure after DMEK. Explanted DSAEK grafts were evaluated by light microscopy.

Results: The mean (±SD) time period between DSAEK and DMEK surgery was 15±8 months (range, 6-31 months). Preoperative CDVA was 1.72±0.62 (logMAR). After DMEK, CDVA improved significantly to 0.78±0.48 at 1 month and to 0.23±0.24 after 12 months (P=0.022). Visual acuity data after DMEK were significantly better compared to preoperative values. The average CCT after DMEK decreased significantly from 869±210 µm (preoperative) to 505±45 µm (1 month postoperative) (P<0.001) and remained stable over 12 months. The ECD decreased from 2,589±209/mm2 (preoperative) to 1,691±589/mm2 (12 months postoperative). Rebubbling DMEK was required in three patients (=20%).

Conclusion: DMEK represents a feasible and safe procedure in achieving better functional results compared to DSAEK. Visual acuity and optical quality can be effectively reestablished after unsuccessful primary DSAEK surgery even in patients with long-standing corneal decompensation. Further investigations are required to validate the preliminary clinical findings.

Keywords: DMEK; DSAEK; corneal edema; corneal transplantation.

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Conflict of interest statement

Disclosure BA, ASL, and IS have no financial interests. MS reports consultancy for Oculus, Oertli, Santen, and Zeiss. TK reports consultancy and research for Abbott/J&J, Alcon/Novartis, Oculentis, Oculus, Presbia, Schwind, and Zeiss; consultancy for Allergan, Bausch & Lomb, Dompé, Geuder, Med Update, Merck, Rayner, Santen, Staar, Tear Lab, Thea, Thieme, Uni-Med Verlag, and Ziemer; research for Avedro and Hoya; personal fees from Allergan, Bausch & Lomb, Dompé, Geuder, Med Update, Merck, Rayner, Santen, Staar, Tear Lab, Thea, Thieme, Uni-Med, and Ziemer; grants and other from Avedro and Hoya; and grants and personal fees from Carl Zeiss, Johnson&Johnson, Novartis/Alcon, Oculentis, Oculus, Schwind, Presbia, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
CDVA after DSAEK and DMEK. Notes: Post DSAEK, best CDVA documented after DSAEK; preoperative, CDVA immediately before DMEK; post DMEK, postoperative CDVA 1 month, 3 months, 6 months, and 12 months after DMEK; statistically significant differences between CDVA after DSAEK and 12 months after DMEK; *statistically significant differences between CDVA at various time points after DMEK. Abbreviations: CDVA, corrected distance visual acuity; DMEK, Descemet membrane endothelial keratoplasty; DSAEK, descemet stripping automated endothelial keratoplasty; logMAR, logarithm of the minimum angle of resolution.
Figure 2
Figure 2
Changes in CCT after DMEK. Note: *Statistically significant differences (P<0.05) between pre and postoperative CCT. Abbreviations: CCT, Central corneal thickness; DMEK, Descemet membrane endothelial keratoplasty.
Figure 3
Figure 3
Photomicrograph showing fibrosis (arrow) and edema (asterisk) of an explanted lamellar graft. Notes: Stain, periodic acid-Schiff; original magnification ×200).
Figure 4
Figure 4
Photomicrograph showing remnants of the original Descemet membrane on the peripheral surface of the failed DSAEK graft. Notes: The retained Descemet membrane is characterized by occasional excrescences produced by diseased endothelial cells in a patient with Fuchs endothelial dystrophy (arrow heads). The donor Descemet membrane of the graft tissue displays a complete loss of endothelial cells (arrows). Stain periodic acid-Schiff; original magnification ×200). Abbreviation: DSAEK, descemet stripping automated endothelial keratoplasty.
See this image and copyright information in PMC

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