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Descemet membrane endothelial keratoplasty (DMEK) for a decompensated penetrating keratoplasty (PK) graft in the presence of a long glaucoma tube

Poster Details

First Author: V.Liarakos GREECE

Co Author(s):    M. Satue   E. Livny   K. van Dijk   L. Ham   I. Dapena   G. Melles     

Abstract Details

Purpose:

To evaluate the feasibility and efficiency of performing Descemet membrane endothelial keratoplasty (DMEK) for treating endothelial insufficiency of a penetrating keratoplasty (PK) graft in the presence of a long glaucoma drainage device (GDD) tube in the anterior chamber.

Setting:

Netherlands Institute for Innovative Ocular Surgery / Tertiary referral center.

Methods:

A 42-year-old male patient was referred with a long-standing decompensated primary PK in his phakic right eye. To control glaucoma, a GDD had been implanted in the temporal-superior quadrant of the eye, with its tube extending 4-5 mm in the anterior chamber. Specific modifications and adjustments of the standardized ‘no-touch’ DMEK technique are introduced and described in order to handle particular challenges. Anterior segment optical coherence tomography (AS-OCT) images, central corneal thickness (CCT) and best corrected visual acuity (BCVA) were evaluated before surgery and at 3 and 6 months postoperatively.

Results:

An uncomplicated adequately modified ‘no-touch’ DMEK was performed. Specific care was attributed to the posterior uneven host areas and a modified technique was utilized to unfold the graft directly over the GDD tube. The postoperative course was uneventful. One day postoperative, the graft was attached across the entire posterior corneal surface. Pachymetry decreased from 1300 μm preoperatively to 800 μm at one week postoperatively and the primary PK-graft started to clear up. After six months, BCVA improved from 3/300 (0.01) (preoperative) to 20/80 (0.25) and CCT measured 550 μm with the DM-graft still attached. Intraocular pressure ranged 8-12mmHg during follow-up.

Conclusions:

A modified ‘no-touch’ DMEK technique proved a feasible treatment option for a decompensated primary PK-graft in the presence of a long GDD tube in the anterior chamber.

Financial Disclosure:

One or more of the authors receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented

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