Stromal Scars; Are They An Absolute Contraindication For Dmek Surgery?

To evaluate the success of DMEK surgery in a patient with a preexisting corneal scar.

Egypt Air Hospital, Cairo, Egypt

A 62 year old male patient with no history of clinical significance came complaining of blurring and drop of vision in his left eye post catract surgery. He had underwent cataract surgery 3 months prior and had received medical treatment for his condition eversince with no evident improvement. On examination, the visual acuity was counting fingers 30cm; slitlamp examination revealed pseudopahkic bullous keratopathy, a diagonal stromal scar and iatrogenic iris atrophy, his B san and VEP were unremarkable. The patient was scheduled for DMEK surgery which was uneventful. On the first day postoperatively. the graft was in place and properly oriented with an evident airbubble despite of the stromal scar. On his second visit one week postoperatively, the cornea was still edematous with no signicant improvement in his condition. The patient continued on 2 hourly steroid drops and was rescheduled for a second follow up after one more week. On week 2 the cornea was still edematous and anterior segment OCT revealed a partial detachment of the descemet's membrane. The patient was admitted for rebubbling on the next day and on his subsequent follow up, there was significant improvement of his condition wth resolving corneal edema and better view of the anterior segment. One week following the rebubbling, the cornea was clear with an excellent visualization of the anterior segment and fundus. The vision improved to 6/20 and the patient has been stable over a 4 year follow up period. 

DMEK sugery is possible despite the presence of a corneal scar. However, it might predispose to descemet's membrane detachment, so extra care and follow up using anterior segment OCT should be considered as well as the use of Sulfur hexafluoride (SF6) to offer a longer temponading period and to decrease incidence of rebubbling.