Preoperative evaluation in descemet membrane endothelial keratoplasty for secondary penetrating keratoplasty graft failure
First Author: K.Safadi ISRAEL
Co Author(s): R. Kaufman A. Solomon I. Lavy
To emphasis the importance of preoperative evaluation and present the clinical outcomes of DMEK performed for Secondary PKP graft failure.
A retrospective medical records review of patients that underwent DMEK for failed PKP at Hadassah Medical Centre in 2018-2019.
Visual acuity was measured according to Snellen chart. Pachymetry was assessed pre and post operatively by anterior OCT (Casia II). The graft size was assessed pre-operatively according to the original PK graft size and posterior morphological features such as graft-host interphase scarring and anterior synechiae, examined by anterior OCT (Casia II).
Included were 15 patients (8 males) and 15 eyes. Mean age at performing DMEK was 63 years. Before performing DMEK for failed PKP, 9 eyes underwent one PKP, 5 eyes underwent two PKP's and 1 eye underwent three PKP's. Mean visual acuity before DMEK was 0.04, one month after DMEK was 0.16 and at last follow-up (between 3-6 months after DMEK) increased to 0.3. One eye needed secondary DMEK because of fully detached graft. Of the 15 eyes, only three required rebubbling in the early postoperative phase.
DMEK may be a viable option to manage secondary PKP graft failure. Preoperative evaluation is essential and plays a key role in planning the operation individually. Thereby, increases the success rate of the procedure in many cases with high opportunity to improve visual acuity. Even though the outcomes of DMEK after PKP are not as successful as those after primary PKP, still DMEK after PKP is a promising procedure that provides many advantages like minimally invasive procedure, avoidance of sutures, ocular surface and wound healing complication and lower risk of allograft rejection.