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Session Title: Cornea surgical I
Session Date/Time: Tuesday 08/10/2013 | 08:00-10:30
Paper Time: 09:36
Venue: Forum (Ground Floor)
First Author: : I.Dapena THE NETHERLANDS
Co Author(s): : R. Yeh L. Baydoun J. Cabrerizo K. van Dijk L. Ham G.
To determine the various causes of unexpected incomplete visual rehabilitation after Descemet membrane endothelial keratoplasty (DMEK).
Retrospective cohort study at the Netherlands Institute for Innovative Ocular Surgery.
From a larger group of 400 consecutive DMEK surgeries, the last 200 eyes were retrospectively reviewed for visual discomfort despite a best corrected visual acuity (BCVA) of ?20/25 (?0.8) or unexpected subnormal BCVA (?20/28; ?0.7) at 6 months after DMEK. Biomicroscopy, fundoscopy, Pentacam imaging, non-contact specular microscopy, anterior segment optical coherence tomography (OCT), and surgical videos were used to determine the causes of incomplete visual rehabilitation.
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.
In contrast to earlier endothelial keratoplasty techniques, that may frequently be associated with undefined transplant-related subnormal visual outcomes, incomplete visual rehabilitation after DMEK may virtually always be explained by concomitant ocular pathology or evident graft failure.
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