Recurrent Dmek Failures Related To Intraocular Tutoplast

To report a unique case of recurrent Descemet Membrane Endothelial Keratoplasty (DMEK) failure associated with intraocular exposure to Tutoplast®, a biocompatible, dehydrated human pericardium graft.

A tertiary ophthalmic hospital managing anterior segment and corneal pathology.

A 69-year-old male with a history of pseudophakic bullous keratopathy (PBK) secondary to multiple glaucoma surgeries, including a PAUL glaucoma implant, experienced three consecutive DMEK failures. Each failure presented with progressive inferior corneal edema despite uneventful surgery and full graft attachment. Further evaluation revealed that a pericardium implant (Tutoplast®) used to seal a prior sclerostomy site was protruding into the anterior chamber and contacting the inferior corneal endothelium. This interaction was associated with endothelial cell dysfunction, leading to graft failure. Following removal of the Tutoplast and replacement with a scleral patch, the patient underwent a fourth DMEK, which remained clear and functional at nine months postoperatively.

This is the first reported case linking intraocular Tutoplast exposure to recurrent DMEK failure. It highlights the importance of thorough preoperative assessment and the need to consider potential interactions between implanted materials and the corneal endothelium. Surgeons should be cautious when using pericardium grafts in glaucoma surgery, as despite being marketed as biocompatible, they may lead to unintended complications affecting corneal graft viability.