Original articleCauses of Primary Donor Failure in Descemet Membrane Endothelial Keratoplasty
Section snippets
Methods
From a larger series of patients who underwent DMEK for Fuchs endothelial dystrophy or bullous keratopathy,18 11 cases showed a primary graft failure, namely, no clearance of the grafted cornea within the first three to four weeks after surgery. The patient group included three men and eight women; patient age averaged 69.4 years (standard deviation [SD] ± 13.3 years; Table).
For all DMEK procedures, grafts were obtained from donor globes less than 36 hours post mortem. From the globes,
Results
From a total of 11 DMEK failures, six eyes showed a complete detachment, that is, a donor Descemet-roll was seen floating in the anterior chamber within the first week after surgery. Of the remaining five eyes, two had a partial detachment, and in three eyes the graft was attached but failed to clear (Table).
In the six eyes with a complete detachment, an upside-down orientation of the graft was considered the most likely cause of failure in two eyes (Cases 8 and 10; Table). In both cases,
Discussion
DMEK may give faster and more complete visual rehabilitation than posterior lamellar keratoplasty techniques procedures previously described by us, and popularized in the United States as DLEK and DSEK/DSAEK/FS-DSEK.18 With all of these techniques, the most apparent complication is incomplete attachment of the unsutured, donor posterior transplant to the recipient posterior stroma. Recently, we reported that up to one-third of DMEK cases may show a detachment of the graft in the early
Lisanne Ham, MSc, graduated as a Medical Biologist in 2007. She is currently a Physician Assistant at Melles CorneaClinic Rotterdam, and a Junior Technician at Amnitrans Eyebank Rotterdam. Both organizations are part of the Netherlands Institute for Innovative Ocular Surgery (www.niios.com), in Rotterdam, The Netherlands.
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Lisanne Ham, MSc, graduated as a Medical Biologist in 2007. She is currently a Physician Assistant at Melles CorneaClinic Rotterdam, and a Junior Technician at Amnitrans Eyebank Rotterdam. Both organizations are part of the Netherlands Institute for Innovative Ocular Surgery (www.niios.com), in Rotterdam, The Netherlands.