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Repeat Descemet’s membrane endothelial keratoplasty

Poster Details

First Author: Z.Hlinomazova CZECH REPUBLIC

Co Author(s):    E. Hrdlickova   L. Filipova   M. Filipec              

Abstract Details


To describe clinical indications, outcome and complications of repeat Descemet’s membrane endothelial keratoplasty (re-DMEK).


European Eye Clinic Lexum, Prague and Ostrava, Czech Republic


From a retrospective series of 250 consecutive DMEK surgeries operated by a single surgeon, 9 eyes of 9 patients underwent re-DMEK for graft detachment after initial DMEK. The average patient age was 63.2±12 years, follow-up was 6 months. Time delay of secondary DMEK was 3 days to 28 months. Indications of re-DMEK were persistent graft detachment and graft failure after primary DMEK, and attached lamella with central folds. The re-DMEK eyes were evaluated for decimal best-corrected visual acuity (BCVA), endothelial cell density (ECD), pachymetry, and intraoperative and postoperative complications.


Six eyes requiring re-DMEK were within the first 50 out of 250 consecutive DMEK surgeries. At 6 months, BCVA was 0.5 and better in 7 eyes (78%), 0.8 and better in 3 eyes (33%), and 1.2 in 1 eye (11%). Average donor ECD decreased from preoperative 2985 cells/mm2 to 1298 cells/mm2 at 6 months. Mean pachymetry decreased from 820 mm to postoperative 560 mm. Very difficult stripping of corneal graft lamella was the most important intraoperative complication in all cases. Complications after re-DMEK included graft failure (1x), graft detachment requiring rebubbling (1x), secondary glaucoma (2x). No eye received tertiary DMEK.


In the management of persistent graft detachment and graft problems after primary DMEK, re-DMEK proved to be a suitable procedure. Satisfactory BCVA may be achieved, although generally lower than after primary DMEK. Complications after re-DMEK are not more frequent than after primary DMEK. The learning curve of the surgeon in this surgery is obvious.

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