Descemet membrane endothelial keratoplasty for graft failure following penetrating keratoplasty.
OBJECTIVE
Descemet membrane endothelial keratoplasty (DMEK) is superior to penetrating keratoplasty (PK) in terms of visual rehabilitation, intraoperative safety and risk of rejection. Therefore, it seems reasonable to perform DMEK in eyes with endothelial failure following PK. We herein report our first clinical results.


METHODS
Nineteen eyes with endothelial graft failure following PK were treated with DMEK. The majority of these eyes (12) had limited visual potential. The major indication for DMEK was pain relief in patients with bullous keratopathy. Visual acuity (VA), central corneal thickness (CCT), rate of graft dislocations, graft survival, graft rejections and other complications were extracted from the medical records.


RESULTS
Although comorbidities limiting VA were present in 12 of the 19 eyes, VA increased from 0.05 to 0.1 (median) in 16 eyes. CCT decreased substantially (range 63-363 μm). Rebubbling was necessary in five eyes with incomplete graft adherence. There were two immunologic graft reactions and three graft failures. No major complications like endophthalmitis or expulsive bleeding occurred.


CONCLUSIONS
DMEK is feasible to treat endothelial graft failure following PK. This is even true for eyes with limited visual potential.
Eye Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany. sonja.heinzelmann@uniklinik-freiburg.de.
Sonja
S
Heinzelmann
Eye Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany.
Daniel
D
Böhringer
Eye Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany.
Philipp
P
Eberwein
Eye Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany.
Thabo
T
Lapp
Eye Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany.
Thomas
T
Reinhard
Eye Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany.
Philip
P
Maier
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014792:Visual Acuity
Cornea; DMEK; Graft failure; Keratoplasty; PK