Management Of Endothelial Failure After Non-Stripping Descemet Membrane Endothelial Keratoplasty Under Previous Penetrating Keratoplasty
Published 2025 - 43rd Congress of the ESCRS
Reference: PO091 | Type: Case Report | DOI: 10.82333/1nkb-9c10
Authors: Eva Ramón* 1 , Ronald Steven II Medalle 2 , Jorge L. Alió del Barrio 3
1Department of Ophthalmology,IMO Grupo Miranza,Barcelona,Spain;Research, Development and Innovation Department,Vissum Grupo Miranza,Alicante,Spain, 2Cornea and Refractive Service,Associated Cebu Eye Specialists,Cebu,Philippines;Department of Ophthalmology,Cebu Institute of Medicine,Cebu,Philippines;Research, Development and Innovation Department,Vissum Grupo Miranza,Alicante,Spain, 3Department of Cornea and Refractive Surgery,Vissum Grupo Miranza,Alicante,Spain;Department of Ophthalmology,Universidad Miguel Hernandez,Alicante,Spain
Purpose
To describe the management of endothelial failure after a penetrating keratoplasty (PKP) and a Descemet membrane endothelial keratoplasty performed without host descemetorhexis (ns-DMEK), by implanting a third endothelial graft without removal of the two failed descemetic layers.
Setting
Case report.
Report of case
A 66-year-old pseudophakic woman with a piggyback toric implantable collamer lens, who had received three previous PKP for Fuchs Endothelial Dystrophy and a subsequent ns-DMEK for secondary endothelial failure in the left eye, presented with a third endothelial failure. She underwent a second ns-DMEK. She was followed-up for one year.
No intraoperative or postoperative complications occurred. Corrected distance visual acuity was restored from 20/100 to 20/25. Corneal transparency and normal pachymetry values were achieved and maintained for the duration of the follow-up. Despite the presence of multiple DM layers, optical transparency of the cornea remained clinically unaffected without posterior corneal haze. The patient reported no complaints of poor quality of vision or visual phenomena.
Conclusion/Take home message
The juxtaposition of three descemetic grafts did not impact corneal transparency and endothelial graft function in our case, providing further evidence that host descemetorhexis may be avoided during DMEK in selected patients. Further studies with larger samples are necessary to confirm these results.
These novel lamellar techniques open new doors to rescuing failed PKs, helping to overcome previous limitations linked to successive penetrating grafts and offering better and faster visual results with much reduced intraoperative and postoperative risks. Corneal specialists should be aware of the modern surgical alternatives available to them for the rehabilitation of a patient’s visual function when faced with a failed corneal transplant.