ESCRS - PO283 - Corneal Guttae After Descemet Membrane Endothelial Keratoplasty (Dmek)

Corneal Guttae After Descemet Membrane Endothelial Keratoplasty (Dmek)

Published 2022 - 40th Congress of the ESCRS

Reference: PO283 | Type: Free paper | DOI: 10.82333/tkk7-wf78

Authors: Keamela Vasanthananthan* 1 , Esther Groeneveld- van Beek 2 , Jessica Lie 2 , Robert Jan Wijdh 3 , Remco Stoutenbeek 3 , Vincent Bourgonje 1 , Gerrit Melles 1 , Silke Oellerich 4 , Viridiana Kocaba 1

1Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands;Melles Cornea Clinic,Rotterdam,Netherlands, 2Amnitrans EyeBank,Rotterdam,Netherlands;Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands, 3UMC Groningen,Groningen,Netherlands, 4Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands

Purpose

To report on the occurrence of corneal guttae after Descemet membrane endothelial keratoplasty (DMEK) and their clinical implications in eyes operated on for Fuchs endothelial corneal dystrophy (FECD). 

Setting

Retrospective case series conducted at the Netherlands Institute for Innovative Ocular Surgery.

Methods

Case series of 12 eyes (12 patients) operated on for FECD at two tertiary referral centers between 2008 and 2020. Average patient age was 63±12 years, 4 patients were female and 8 were male, 50% was pseudophakic. Specular and confocal microscopy were evaluated for the presence of guttae. Analyzed clinical outcome parameters included endothelial cell density (ECD), corneal clarity and rate of postoperative complications. 

Results

During routine postoperative consultation, specular microscopy images showed suspected recurrence of guttae; in most cases after 1 month. Guttae presence was confirmed in 10 cases by confocal microscopy and in one case by histology. Six patients had undergone bilateral DMEK, but all showed recurrence of guttae only in one eye. In 11 eyes guttae recurred after primary DMEK, while in one eye recurrence was after a re-DMEK, with no signs of guttae after primary DMEK.  One eye required a re-DMEK at 56 months postoperatively for graft failure, while the other eyes remained clear until the last available follow-up. Preoperative donor ECD decreased from 2624±149 cells/mm2 (n=12) to 1092±452 cells/mm2 (n=8) at 1-year postoperatively. 

Conclusions

Recurrence of guttae after DMEK is most likely due to guttae on the donor graft that were not detectable by routine slit-lamp and light-microscopy evaluation in the eye bank. Better screening methods for guttae detection may need to be developed for eye banks to avoid transplantation of grafts with guttae that could potentially result in optical complaints and an increased risk of graft failure.