title: Potential causes of incomplete visual rehabilitation at 6 months postoperative after descemet membrane endothelial keratoplasty.
abstract: OBJECTIVE
  To determine the various causes of unexpected incomplete visual rehabilitation at 6 months postoperative after Descemet membrane endothelial keratoplasty (DMEK).
  
  
  METHODS
  Retrospective study of prospectively collected data at a tertiary referral center.
  
  
  METHODS
  From a larger group of 400 consecutive DMEK surgeries, the last 200 consecutive eyes were reviewed for visual discomfort despite a best-corrected visual acuity (BCVA) of ≥20/25 (≥0.8) or unexpected subnormal BCVA (≤20/28; ≤0.7) at 6 months after DMEK. Biomicroscopy, funduscopy, Pentacam imaging, noncontact specular microscopy, anterior segment optical coherence tomography, and surgical videos were used to determine the causes of incomplete visual rehabilitation.
  
  
  RESULTS
  A total of 69 eyes out of 178 eyes that were included in the analysis (38.8%) presented with incomplete visual rehabilitation after DMEK, further categorized as "primarily patient-related" in 40 of 178 (22.5%), "primarily graft-related" in 21 of 178 (11.8%), and a combination of "patient-/graft-related" in 8 of 178 cases (4.5%). Unrecognized pre-existing ocular pathology and/or posterior segment disease in 19 of 178 eyes (10.7%), clinically significant corneal irregularities and/or central corneal scarring often secondary to long-standing preoperative corneal edema in 14 of 178 eyes (7.9%), or (partial) graft detachment in 20 of 178 eyes (11.2%) were the main causes of unexpected incomplete visual rehabilitation. Transient or persistent monocular ghost images or diplopia occurred in 10 of 178 eyes (5.6%), sometimes requiring contact lens fitting.
  
  
  CONCLUSIONS
  In contrast to earlier endothelial keratoplasty techniques that may frequently be associated with undefined transplant-related subnormal visual outcomes, incomplete visual rehabilitation after DMEK may virtually always be explained by concomitant ocular pathology or evident graft failure.
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic, Rotterdam, Netherlands.
authors.forename: Isabel
authors.initials: I
authors.lastname: Dapena
authors.forename: Ru-Yin
authors.initials: RY
authors.lastname: Yeh
authors.forename: Lamis
authors.initials: L
authors.lastname: Baydoun
authors.forename: Javier
authors.initials: J
authors.lastname: Cabrerizo
authors.forename: Korine
authors.initials: K
authors.lastname: van Dijk
authors.forename: Lisanne
authors.initials: L
authors.lastname: Ham
authors.forename: Gerrit R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D006084:Graft Rejection / Q000150:complications / Q000503:physiopathology; D006801:Humans; D008297:Male; D033401:Microscopy, Acoustic; D008875:Middle Aged; D009887:Ophthalmoscopy; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D015354:Vision, Low / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult