Spontaneous Corneal Clearance And Complete Endothelial Layer Recovery After Central Graft Detachment In Descemet’S Membrane Endothelial Keratoplasty (Dmek).

Published 2023 - 41st Congress of the ESCRS

Reference: PO0658 | DOI: 10.82333/52yd-tb84

Authors: Carla Arteaga Henríquez* ¹ , Luis Fernández-Vega Cueto-Felgueroso ² , Carlos Lisa ² , Belen Alfonso ² , Jose F. Alfonso ²

¹University Hospital of the Canary Islands,Tenerife,Spain, ²Fernández-Vega Ophthalmological Institute,Oviedo,Spain

To report a case of spontaneous corneal clearance and complete endothelial layer recovery after central graft detachment in Descemet’s membrane endothelial keratoplasty (DMEK).

Fernández-Vega Ophthalmological Institute (Oviedo, Spain)

Case report

A 64 years-old man diagnosed of bilateral Fuchs’ dystrophy visited the Institute seeking for therapeutic options. In his left eye (LE), his central corneal thickness (CCT) was 629 microns. A DMEK was suggested. Two weeks after DMEK, a peripheral graft detachment was observed, and resolved by rebubbling. After three months, the CCT was 535 microns. Despite the presence of a central graft detachment, the cornea showed a complete clearance with an adequate endothelial cell count. Therefore, a conservative approach (i.e., observation) was decided. Three months later, the recipient cornea remained transparent but a significant opacification of the detached graft was observed. The graft was surgically removed and the cornea persisted transparent.

Endothelial graft detachment is a common complication of DMEK. It is well known that endothelial cells have the ability of migration and regeneration. In the present case, endothelial cells may have migrated from peripheral cornea and/or from the detached graft leading to a complete corneal clearance and recovery of the endothelial layer. This case thus highlights the importance of surveillance after DMEK. Graft failure after graft detachment must be confirmed before any decision making regarding future interventions.