LATE SPONTANEOUS REATTACHMENT OF THE GRAFT AFTER A DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY (DMEK).

Published 2022 - 26th ESCRS Winter Meeting

Reference: P113 | Type: Abstracts | DOI: 10.82333/5sgq-cq57

Authors: German Allendes-Urquiza* ¹ , Edith Angélica Beatriz Son Camey ¹ , María Ángeles Montes Mollon ²

¹Ophthalmology resident,Hospital Universitario Príncipe de Asturias,Madrid,Spain, ²Cornea and Anterior Segment,Hospital Universitario Príncipe de Asturias,Madrid,Spain

Purpose

To present a case of late spontaneous reattachment of the graft after a DMEK

Setting

Cornea and Anterior Segment, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.

Methods

A 78-year-old woman with corneal decompensation after cataract surgery in the right eye (RE) is admitted for a DMEK. The surgery did not present complications, the donor graft was fully attached and well centered. The first day after surgery examination revealed a well-positioned transplant, with a clear center and no signs of detachment under the gas bubble. Three days after surgery, there was a partial detachment (less than 10% of the graft surface) in the temporal zone, with sub-epithelial edema. The gas bubble was at 25% size. Treatment with topical corticosteroids and antibiotics continued. After a week, the visual acuity (VA) of the RE was 20/200, so a macular and anterior segment optical coherence tomography (OCT) was performed. It showed cystoid macular edema (CME) and the graft had a central detachment with peripheric attachment. One dose of intravitreal Ranibizumab was administered, presenting VA of 20/40 three weeks after the injection. New OCTs were performed, showing partial re-attachment of the donor graft, with distances of 353 to 74 µm from stroma to the graft in 4 months

Results

We present a case in which after DMEK surgery, the patient presented a graft detachment. The possibility of reverse placement of the endothelium was considered, suspecting an upside-down of the graft due to the clinical characteristics, although it did not present corneal alterations. Surgical correction was not performed due to the development of CME. After several months of treatment and a decrease in CME, it was observed that the graft increased its adhesion spontaneously.

Conclusion

DMEK offers the opportunity for visual gain in cases of endothelial dysfunction. It is used to treat corneal disorders. Like other surgeries, some factors may affect negatively the results. Graft detachment may be the most frequent complication after DMEK, occurring in up to 82% of cases and this can be because of different causes. One of these is that the edges of the graft fold “inward” or curl in a roll toward the patient´s posterior stroma underneath the rest of the donor membrane. Other causes are insufficient support from the air bubble after surgery, mistakenly implanting the graft upside down, use of plastic materials during surgery, and stromal irregularities underneath the site of the main incision. Awaiting spontaneous clearance, or surgical intervention like air/gas re-injection inside the anterior chamber (graft re-bubbling) or re-orientation of an upside-down or can be considered if there is no resolution of the detachment. Another complication can be CME, with an incidence after DMEK of 7 to 13.8%.

There are no reports of spontaneous reinsertion of the DMEK graft after so many month and with this level of detachment, so we consider it convenient to disclose this clinical case.