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Secondary DMEK following failed primary DMEK

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Abstract

Purpose

To report the outcomes of secondary Descemet Membrane Endothelial Keratoplasty (DMEK) performed for failed primary DMEK.

Methods

The medical records of all patients undergoing secondary DMEK due to failure of primary DMEK were reviewed. Reasons for failure were sought and best-corrected visual acuity (BCVA), endothelial cell density (ECD) and complications of secondary DMEK were evaluated.

Results

A total of 10 cases undergoing secondary DMEK following failed primary DMEK were identified. Presumed reasons for failure included donor ECD ≤ 2300 cells/mm2 (n = 4), difficulty during graft preparation (n = 2), graft detachment (n = 2), acute angle closure due to retroiridal air dislocation (n = 1), inverse graft positioning (n = 1) and phacoemulsification (n = 1). Eyes with low visual potential were not excluded from the study group. We should note that one patient (case no7) had both low ECD and graft detachment as reasons for failure and as a result he is counted twice.

Median BCVA (decimal fraction) increased from 0.1 (range, 0.01; 0.3) to 0.5 (0.05; 1.0) at one month and remained stable thereafter. A BCVA of 0.5 or higher was achieved in 7 cases at the final follow-up. Mean ECD fell from 2628 ± 284 cells/mm2 to 1391 ± 252cells/mm2 at 6 months (47% reduction) and 959 ± 225cells/mm2 at 24 months (64% reduction) (P ≤ 0.028). Complications included the incomplete removal of the primary graft and mild iris bleeding, decompensation of a preexisting primary open-angle glaucoma and retroiridal air dislocation.

Conclusions

Apart from low donor ECD, surgical challenges, i.e., difficulty with graft preparation, inverse graft positioning, and retroiridal air dislocation, were main reasons for failure of primary DMEK. Secondary DMEK showed a good safety profile and reasonable visual outcomes.

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Data availability

All data and materials of our research are available for evaluation.

Abbreviations

DMEK:

Descemet membrane endothelial keratoplasty

BCVA:

Best-corrected visual acuity

CF:

Counting fingers

DSAEK:

Descemet stripping endothelial keratoplasty

ECD:

Endothelial cell density

CCT:

Central corneal thickness

ECL:

Endothelial cell loss

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Funding

No funding was received for this research.

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Authors and Affiliations

  1. First Department of Ophthalmology, School of Medicine, National and Kapodistrian University of Athens, 11527, Athens, Greece

    Konstantinos Droutsas, Palaiologos Alexopoulos & Ioannis Giachos

  2. Department of Ophthalmology, Philipps University, 35043, Marburg, Germany

    Konstantinos Droutsas, Eleftherios Giallouros, Walter Sekundo & Apostolos Lazaridis

Authors
  1. Konstantinos Droutsas
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  2. Palaiologos Alexopoulos
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  3. Ioannis Giachos
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  4. Eleftherios Giallouros
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  5. Walter Sekundo
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  6. Apostolos Lazaridis
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Contributions

KD designed and conducted the study. All authors analyzed the results and prepared the manuscript.

Corresponding author

Correspondence to Ioannis Giachos.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Droutsas, K., Alexopoulos, P., Giachos, I. et al. Secondary DMEK following failed primary DMEK. Int Ophthalmol 41, 3287–3293 (2021). https://doi.org/10.1007/s10792-021-01890-2

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  • DOI: https://doi.org/10.1007/s10792-021-01890-2

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