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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

Purpose:

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

Setting:

European Eye Clinic Lexum, Prague and Ostrava, Czech Republic

Methods:

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.

Results:

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.

Conclusions:

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.

Financial Disclosure:

NONE

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