Long-Term Results Of Postoperative Rescuing Of Inverted Dmek Grafts: Two Case Reports

Published 2022 - 40th Congress of the ESCRS

Reference: FPM02.09 | Type: Free paper | DOI: 10.82333/8fnc-g731

Authors: Ariño-Gutierrez Mayte* ¹ , Gregory Moloney ² , Barbara Burgos ¹ , David Diaz-Valle ¹ , Ricardo Cuiña ¹ , Jose Manuel Benítez del Castillo ¹ , Beatriz Vidal ¹ , Pedro Arriola ¹

¹Cornea, inflammation and Anterior Segment (USIO),Hospital Clinico San Carlos,Madrid,Spain, ²Eye Care Center,Vancouver,Canada

Purpose

The purpose of this study was to report the clinical outcomes of postoperative repositioning of 2 inverted Descemet membrane endothelial keratoplasty (DMEK) grafts in 2 patients with endothelial dysfunction.

Setting

Two patients underwent DMEK surgery in a tertiary referral corneal clinic

Methods

Initial surgery was performed by 2 different corneal surgeons, and a third surgeon repositioned both cases. In the early postoperative period, partial and subtotal detachments were observed at slitlamp and inverted graft orientation was confirmed by anterior segment optical coherence tomography. In both cases, uneventful reposition of the inverted graft was performed by an experienced DMEK surgeon on days 2 and 9 after initial DMEK surgery.

Results

Repositioning surgery was successful in both patients. The

Moutsouris sign was used to confirm proper orientation. One patient had

total graft adherence at day 1 postrepositioning. The second patient

required a rebubbling procedure, despite the correct orientation confirmed

by using anterior segment optical coherence tomography. Visual acuity

and corneal thickness were stable in both cases (case 1: 20/30, 567 mm;

case 2: 20/80, 543 mm). Both patients had clear corneas and functional cell

counts 2 years after repositioning (451 cells/mm2 and 1052 cells/mm2).

Conclusions

Postoperative repositioning of an inverted DMEK graft may be a viable procedure to delay or prevent regrafting.