title: Spontaneous long-term course of persistent peripheral graft detachments after Descemet's membrane endothelial keratoplasty.
abstract: BACKGROUND
  Peripheral corneal graft detachment after Descemet's membrane endothelial keratoplasty (DMEK) is a frequently occurring postoperative complication. The natural course of these persistent peripheral detachments over time is not known.
  
  
  METHODS
  166 patients were surveyed by slit-lamp-adapted optical coherence tomography (SL-OCT) directly after surgery, during first postoperative week, 4 weeks, 3, 6 and 12 months, postoperatively. Patients with a persistent peripheral graft detachment 4 weeks after DMEK (n=16) were observed for their spontaneous course up to 1 year postoperatively.
  
  
  RESULTS
  Persistent graft detachments could be characterised into two phenotypes: peripheral roll (n=11; 69%) and laminar detachment (n=5; 31%). Maximal length of the detachment did not change in peripheral rolls during observation period (12 months vs 4 weeks, 578±122 µm vs 593±106 µm, p=0.74), whereas laminar detachments spontaneously attached to the host's stroma (12 months vs 4 weeks, 0 µm vs 1088±295 µm, p≤0.001). Central corneal thickness and (peripheral) corneal thickness above the detached area did not significantly change in either group.
  
  
  CONCLUSIONS
  Persistent peripheral graft detachments after DMEK occurred in 10% of patients and had two distinct OCT-phenotypes. Peripheral rolls did not change during the first 12 months, postoperatively. By contrast, peripheral laminar detachments attached spontaneously even months after surgery. Corneal thickness reduction was only observed above peripheral laminar detachment, but not above peripheral rolls.
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Bucher
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Deniz
authors.initials: D
authors.lastname: Hos
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Müller-Schwefe
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Steven
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Cursiefen
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Ludwig M
authors.initials: LM
authors.lastname: Heindl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001768:Blister / Q000601:surgery; D003315:Cornea / Q000473:pathology; D063171:Corneal Pachymetry; D003886:Descemet Membrane / Q000473:pathology*; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010641:Phenotype; D011183:Postoperative Complications; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology
keywords: Cornea; Dystrophy; Treatment Surgery