RE-DMEK (REPEAT DMEK) RESULTS IN PATIENTS WITH PRIMARY DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY FAILURE

To analyze the results of repeated Descemet membrane endothelial keratoplasty (re-DMEK) in patients with failed after primary DMEK.

Retrospective case series study at a tertiary referral center.

re-DMEK was performed in 18 cases (7.1%) after 252 DMEK surgeries in our clinic between January 2020 and January 2023. Best-corrected visual acuity (BCVA), decrease in endothelial cell loss (1st month, 3rd month, 6th month), change in central corneal thickness, rebubling rate, intraoperative and postoperative complications, and re-DMEK success were recorded. 

The mean follow-up period of 18 patients who underwent re-DMEK was 14.17 ± 10.1 months. A statistically significant increase was achieved in the final mean BCVA (0.36, snellen) compared to the mean BCVA in the preoperative period (0.042, snellen) (P=0.001). The mean donor endothelial cell number decreased from 2758 ± 141 cells/mm² to 1794 ± 107 cells/mm² at the 6th month (P = 0.002). The mean central corneal thickness decreased from 764 ± 76 µm at baseline to 626 ± 120 µm at the 6th month (P = 0.002). Clear corneas were obtained in 12 (%62) of the patients who underwent re-DMEK.

re-DMEK is a feasible surgery in the treatment of permanent graft separation and graft failure after primary DMEK. Although it is difficult to reach the visual acuity levels of a successful primary DMEK in re-DMEK, re-DMEK should definitely be considered in cases of primary DMEK failure due to its acceptable visual acuity and fewer complications than penetrating keratoplasty.