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Descemet's membrane endothelial keratoplasty (DMEK) and potential causes of incomplete visual rehabilitation

Session Details

Session Title: Cornea

Session Date/Time: Sunday 16/02/2014 | 08:30-11:00

Paper Time: 10:06

Venue: Linhart Hall (Level -2)

First Author: : Peter PaulCiechanowski SWITZERLAND

Co Author(s): :    Isabel Dapena   Vasilis Liarakos   Lamis Baydoun   Korine van Dyke   Lisanne Ham   Gerrit J. Melles

Abstract Details


To determine the causes of incomplete visual rehabilitation after DMEK.


Retrospective cohort study at a tertiary referral center.


Study of the last 200 eyes from a larger group of 400 consecutive DMEK surgeries on visual discomfort or unexpected subnormal visual acuity at 6 months after DMEK. For the evaluation biomicroscopy, funduscopy, Pentacam imaging, anterior segment optical coherence tomography, noncontact specular microscopy and surgical videos were used.


A total of 69 eyes (38%) out of 178 eyes that were included in the analysis, presented with incomplete visual rehabilitation after DMEK, further categorized as ‘primarily patient-related’ in 40/69 (58%), ‘primarily graft-related’ in 21/69 (30%), and a combination of ‘patient-graft related’ in 8/69 (12%) of cases. Unrecognized pre-existing ocular pathology and/or posterior segment disease in 19/69 eyes (28%), clinically significant corneal irregularities and/or central corneal scarring often secondary to long-standing preoperative corneal edema in 14/69 eyes (20%) or (partial) graft detachment in 20/69 eyes (29%), were the main causes of unexpected incomplete visual rehabilitation after DMEK. Transient or persistent monocular ghost images or diplopia occurred frequently in 10/69 eyes (14%), sometimes requiring contact lens fitting.


Concomitant ocular pathology or evident graft failure may virtually always explain incomplete visual rehabilitation after DMEK in contrast to earlier endothelial keratoplasty techniques. FINANCIAL INTEREST: NONE