Descemet Membrane Endothelial Keratoplasty (DMEK) Under Previous DMEK for Secondary Endothelial Graft Failure

Purpose To analyze the impact of performing premarking of the Descemet roll and using SF6 20% on a surgeon's Descemet membrane endothelial keratoplasty (DMEK) learning process. Methods A total of 30 consecutive eyes with endothelial dysfunction undergoing DMEK during the learning curve of a surgeon were retrospectively analyzed. Prior to the study, the surgeon had already performed 10 DMEKs. The first 15 consecutive patients were included in group 1 (no premarking and air tamponade) and the other 15 consecutive patients were included in group 2 (premarking and SF6 tamponade). Main outcome parameters were best-corrected visual acuity (BCVA), endothelial cell density (ECD) loss at 6 months, and intraoperative and postoperative complications. Results Among the 2 groups, BCVA and ECD loss at 6 months were similar. However, there was a statistically significant reduction in primary graft failure (40% vs 0%) and need of rebubbling due to complete or partial graft detachment (40% vs 6%) when comparing group 1 versus group 2. In group 1, half of the patients needing rebubbling had primary graft failure. Conclusions Based on our personal experience, premarking the graft to assess orientation and using a SF6 gas tamponade dramatically reduces the risk of primary graft failure and the need for rebubbling even during the first stages of the learning curve. These findings should encourage surgeons to safely change from Descemet stripping automated endothelial keratoplasty to DMEK.

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

Clinical Ophthalmology ◽

10.2147/opth.s194185 ◽

2019 ◽

Vol Volume 13 ◽

pp. 553-559 ◽

Cited By ~ 2

Author(s):

Bishr Agha ◽

Mehdi Shajari ◽

Anna Slavik-Lencova ◽

Thomas Kohnen ◽

Ingo Schmack

Keyword(s):

Graft Failure ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane

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Descemet Membrane Endothelial Keratoplasty after Penetrating Keratoplasty Graft Failure

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2021.62.6.848 ◽

2021 ◽

Vol 62 (6) ◽

pp. 848-854

Author(s):

Woo Young Son ◽

Min Ji Ha ◽

Woong Joo Whang ◽

Yong-Soo Byun ◽

Hyung Bin Hwang ◽

...

Keyword(s):

Graft Failure ◽

Penetrating Keratoplasty ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane

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Comparison of ACIOL Exchange and Descemet Membrane Endothelial Keratoplasty with ACIOL Retention and Descemet Stripping Automated Endothelial Keratoplasty in the Setting of Pseudophakic Bullous Keratopathy

10.21203/rs.3.rs-499850/v1 ◽

2021 ◽

Author(s):

Biana Dubinsky-Pertzov ◽

Gissela Santaella ◽

Nir Sorkin ◽

Lior Or ◽

Inbal Gazit ◽

...

Keyword(s):

Postoperative Complications ◽

Graft Failure ◽

Good Alternative ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Exchange Group ◽

Retention Group ◽

Demographical Data

Abstract Objective: To compare the clinical outcomes and complications of anterior chamber intraocular lens (ACIOL) exchange and Descemet membrane endothelial keratoplasty (DMEK) with ACIOL retention and Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with PBK.Methods: A multicenter retrospective cohort study. Patients with ACIOL who underwent endothelial keratoplasty procedure due to PBK between 2012-2018 in two tertiary medical centers, were identified. Clinical and demographical data including preoperative and postoperative characteristics were collected.Results: Thirteen eyes in the “DMEK and ACIOL exchange” group and 15 in the “DSAEK and ACIOL retention” group were included in the analysis. Mean BCVA six months postoperatively was 0.51±0.20 LogMAR (Snellen 20/64) and 0.57±0.22 LogMAR (Snellen 20/83) in the “DMEK and ACIOL exchange” group and “DSAEK and ACIOL retention” group, respectively (P=0.38). Graft failure occurred in 6 eyes (40%) in the “DSAEK and ACIOL retention” group; four of them were secondary failures occurring at an average follow-up time of 15±11.9 months. In the “DMEK and ACIOL exchange” group, graft failure occurred in one eye and was a primary failure (P=0.046). In the “DMEK and ACIOL exchange” group, postoperative complications were seen in 4 eyes (30.7%). No postoperative complications were recorded in the “DSAEK and ACIOL retention” group (P=0.035).Conclusion: Despite the lower complication rate, the higher incidence of graft failure and the need for second keratoplasty in the DSAEK group along with the similar visual outcomes, might suggest that in the indication of PBK, ACIOL exchange with DMEK offers a good alternative to ACIOL retention with DSAEK.

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