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Causes that influence the detachment rate after Descemet membrane endothelial keratoplasty

Graefe's Archive for Clinical and Experimental Ophthalmology volume 253, pages 2217–2222 (2015)Cite this article

An Erratum to this article was published on 30 August 2015

Abstract

Purpose

To investigate Descemet graft (DG) detachment rate after Descemet membrane endothelial keratoplasty (DMEK) in relation to DG position.

Methods

A total of 175 consecutive pseudophakic eyes that underwent DMEK (175 eyes for Fuchs endothelial dystrophy) from September 2009 through February 2014 at the Tübingen Eye Hospital DG position were studied retrospectively by surgical video at the end of an operation. A group of 45 eyes showed a decentration of the DG with a stromal gap of ≥1.5 mm over at least 3 clock hours between the descematorhexis edge and the DG. DG detachment was documented at a mean follow-up of 13.9 ± 3.7 months after surgery. DG detachment was defined as a detachment of 20 % or more of the DG surface area. Various donor characteristics and patient characteristics were analyzed.

Results

The best spectacle-corrected visual acuity (BCVA) in the group of eyes with central well-positioned DG differed significantly from those of eyes with decentered DG. The preoperative BCVA in the central well-positioned DG group was 0.63 ± 0.40 logMAR, and in the decentered DG group 0.91 ± 0.51 logMAR (P < 0.001). The postoperative BCVA in the group of eyes with central well-positioned DG was 0.12 ± 0.11 logMAR, and in the group with decentered DG 0.23 ± 0.29 logMAR (P < 0.001). Endothelial cell density and patient characteristics such as age, gender, and intraocular pressure did not differ significantly between the two groups. The group of eyes with central well-positioned DG showed DG detachment in 12 %; the group with decentered DG findings had DG detachment in 87 % (P < 0.001) at the 12 month follow up.

Conclusion

The present findings demonstrate the importance of central well-positioned DG and the relation of disease severity. Central well-positioned DG may reduce the incidence of DG detachment. Overlapping of the donor DG and the host Descemet membrane seems to be responsible for DG detachment. One possible way to enhance graft adhesion could be a larger descematorhexis, which avoids an overlapping. The second possible way could be not waiting too long for surgery to reduce disease severity.

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Competing interests

None; no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

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Ethics approval

This study was approved by the institutional review board of the University of Tübingen, and adhered to the tenets of the Declaration of Helsinki.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Affiliations

  1. Centre for Ophthalmology, University of Tübingen, Tübingen, Germany

    T. Röck, K. U. Bartz-Schmidt, D. Röck & E. Yörük

  2. Department of General Medicine, Ruhr-University Bochum, Bochum, Germany

    M. Bramkamp

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  1. T. Röck
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  2. M. Bramkamp
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  3. K. U. Bartz-Schmidt
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  4. D. Röck
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  5. E. Yörük
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Correspondence to T. Röck.

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Röck, T., Bramkamp, M., Bartz-Schmidt, K.U. et al. Causes that influence the detachment rate after Descemet membrane endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol 253, 2217–2222 (2015). https://doi.org/10.1007/s00417-015-3103-2

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  • DOI: https://doi.org/10.1007/s00417-015-3103-2

Keywords

  • Descemet membrane endothelial keratoplasty (DMEK)
  • Posterior lamellar keratoplasty
  • Descemet graft detachment
  • Centrally positioned Descemet graft
  • Recovery of corneal transparency