Spontaneous corneal clearance despite graft detachment in descemet membrane endothelial keratoplasty.
OBJECTIVE
To describe spontaneous recovery of corneal transparency in 2 cases with nearly complete graft detachment after Descemet membrane endothelial keratoplasty (DMEK).


METHODS
Case series.


METHODS
In 2 patients with Fuchs endothelial dystrophy, DMEK was performed. Through a 3-mm clear corneal tunnel incision, the recipient Descemet membrane and its endothelium was stripped off from the posterior stroma. A 9.5-mm diameter organ-cultured Descemet roll was inserted into a recipient anterior chamber, positioned onto the posterior stroma, and secured by a complete air filling of the anterior chamber for 45 minutes.


RESULTS
At 1 month after uneventful DMEK, both transplanted corneas showed decompensation attributable to subtotal graft detachment. Unexpectedly, corneal transparency improved spontaneously, and at 3 months, both transplanted corneas had a normal pachymetry, despite persistent graft detachment. The patients' visual acuities improved to 20/50 (0.4) and 20/25 (0.8) at 3 months to 20/28 (0.7) and 20/20 (1.0), respectively at 9 months.


CONCLUSIONS
Corneal clearance in the presence of a detached DMEK graft is not consistent with the current concept of endothelial keratoplasty, which requires an (attached) donor endothelial cell layer at the recipient posterior corneal surface. Endothelial transfer, migration, regeneration, or a combination thereof from either the donor or the recipient may explain the visual recovery. These observations suggest that a review of our approach to endothelial keratoplasty and the management of corneal endothelial disorders may be warranted.
Balachandran
Chandra
C
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.
Ham
Lisanne
L
Verschoor
Christianne A
CA
Ong
T San
TS
van der Wees
Jacqueline
J
Melles
Gerrit R J
GR
D000368:Aged; D002452:Cell Count; D003315:Cornea / Q000503:physiopathology*; D016039:Corneal Transplantation; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D006084:Graft Rejection / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D009924:Organ Culture Techniques; D011183:Postoperative Complications; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology