Original articleRepeat Descemet Membrane Endothelial Keratoplasty after Complicated Primary Descemet Membrane Endothelial Keratoplasty
Section snippets
Methods
From a total of 550 consecutive DMEK cases, 17 eyes of 17 patients (8 male, 9 female; 3 phakic, 14 pseudophakic) with an average age of 69±14 years (range, 47–90 years) underwent re-DMEK after unsuccessful primary DMEK. The initial preoperative diagnoses included Fuchs endothelial dystrophy (n = 15), pseudophakic bullous keratopathy (n = 1), and bullous keratopathy after corneal perforation (n = 1). Primary DMEK grafts were removed and replaced by a secondary DMEK graft in a second operative
Indications for Repeat DMEK
We performed re-DMEK in a series of 17 eyes that showed unsatisfactory visual outcomes after primary DMEK and for which improvement could be expected by a transplant replacement. Low visual outcome after primary DMEK was attributed to clinically significant graft detachment (n = 14) and endothelial graft failure (n = 3; Table 3 [available at www.aaojournal.org]; Fig 1).
In eyes with graft detachment, 3 eyes had a detachment of at least one third and 8 eyes of more than one third of the graft
Feasibility of Repeat DMEK
Our study showed that re-DMEK was technically feasible in all eyes that showed graft detachment or DMEK transplant failure. Compared with primary DMEK, some modifications in the operative protocol may be considered in re-DMEK to avoid intraoperative and postoperative complications (Table 2). Unlike a virgin DM during descemetorhexis, a DMEK graft was found to show relatively strong adherence to the host posterior stroma, with a higher risk of graft remnants. Performing a “normal”
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Cited by (60)
Risk Factors for Repeat Descemet Membrane Endothelial Keratoplasty Graft Failure
2021, American Journal of OphthalmologyNon stripping descemet membrane endothelial keratoplasty in difficult cases: A case series
2021, Journal Francais d'OphtalmologieCitation Excerpt :Consequently, Anshu et al. introduced DMEK on failed PK for the first time in 2013 with favorable results [10], confirmed by later studies [2,11–14]. Both DSAEK and DMEK involve the surgical removal of the diseased host endothelial cell layer and Descemet membrane before transplantation (descemetorhexis); a step significantly more challenging on a previously grafted than on a virgin eye because of stronger adherence of the graft to the recipient stroma [15]. Remnants of adherent DM may affect visual outcome as well as graft adherence [16,17]; therefore, interest arose when this step was suggested as non-essential if donor DM was non pathological [18–20].
Corneal transplantation after failed grafts: Options and outcomes
2021, Survey of OphthalmologyCitation Excerpt :Repeat grafts can also have a tendency to detach in the same quadrant,39 and rebubbling may be required in 50% of eyes that require rebubbling for their primary procedure.133 The results of the studies evaluating secondary DMEK after failed initial DMEK are presented in Table 3.5,39,54,133,215 There are variable reports regarding the visual outcomes of secondary DMEK, with some studies reporting that outcomes are comparable with those of primary DMEK when graft failure was treated promptly with secondary DMEK4,133,140,143 and others reporting inferior outcomes39 compared to historical controls.63,198
Postoperative Complications in Medicare Beneficiaries Following Endothelial Keratoplasty Surgery
2020, American Journal of OphthalmologyImmune reactions after modern lamellar (DALK, DSAEK, DMEK) versus conventional penetrating corneal transplantation
2019, Progress in Retinal and Eye ResearchCitation Excerpt :In addition, there are so far only few relevant studies reporting on graft rejection rates in EK patients who would have been considered as high-risk hosts in PK. These (smaller) studies demonstrate relatively low graft rejection rates when compared to high-risk PK (between 0% and 17%) (Anshu et al., 2011; Baydoun et al., 2015b; Heinzelmann et al., 2017; Kim et al., 2012; Mitry et al., 2014), and there is no general consensus whether a high-risk scenario in EK even exists so far. It will be interesting to see whether studies in larger cohorts with longer follow-up can recapitulate this fact and whether it will be necessary to further sub-define “low-low-risk” and “high-low-risk” scenarios in the already low-risk setting of EK in the future.
Supplemental material is available at www.aaojournal.org.
See Editorial on page 6.
Financial Disclosure(s):
The authors have made the following disclosures: G.R.J.M.: Consultant – D.O.R.C. International/Dutch Ophthalmic USA. L.B., I.D., V.S.L.: received a World Ophthalmology Congress 2014 Travel Grant unrelated to the presented work. The other authors have no conflicting relationship to disclose.