Isabel Dapena, Lamis Baydoun, Korine van Dijk, Vasilis Liarakos, Lisanne Ham, and Gerrit Melles Repeat DMEK for unsuccessful previous DMEK Netherlands.

Isabel Dapena, Lamis Baydoun, Korine van Dijk, Vasilis Liarakos, Lisanne Ham, and Gerrit Melles

Repeat DMEK for unsuccessful previous DMEK

Netherlands Institute for Innovative Ocular Surgery; Melles Cornea Clinic; Amnitrans Eye Bank Rotterdam, The Netherlands

Financial Disclosure: Dr. Melles is a Consultant for DORC International. Rest of the authors have no financial interests

Purpose

• To describe:

Feasibility Results Complications

…of repeat-DMEK

550 DMEK cases

Methods

17 Re-DMEK Primary indication: FED (n=15) PPBK (n=1) BK after trauma (n=1) 3 Graft failure

Primary (n=1) Secondary norejection (n=1)

Secondary with rejection (n=1)

>1/3 (n=8)

14 Graft detachment

≤1/3 (n=3) Upside down (n=3)

Dapena et al. Standardized “no touch“ technique in DMEK Arch Ophthalmol 2011

• Re-DMEK uneventful in all eyes

• DM-rhexis under air DMEK graft more firmly attached than

virgin Descemet membrane

• Scraping of detached areas remove possible migrated cells

• Longer air bubble time (>60min) enhance graft attachment

Re-DMEK Surgery

Results

• BCVA: Improved in all eyes in which

re-DMEK was successful BCVA 20/25 (0.8) at 6-12

months: 40-50% of eyes after re-DMEK while 80-90% after primary DMEK

About 1/3 of re-DMEK eyes required contact lens fitting to further improve BCVA

Rodriguez et al. Outcomes of 500 DMEK Ophthalmology 2014 EPUB

Pre-op 703±126 µm (n=17) 6m 515±39 µm (n=16)

ECD

Pachymetry

Results

6m -46% (n=15) 12m -50% (n=13)

Complications

Significant cataract (n=1 out of 3 phakic eyes)

Remnants(n=1)

Detachment (n=6)

Graft failure:Primary (n=1)Secondary (n=2)

Graft detachment occured in 3 eyes of the re-graft in the same (but smaller) area

(green arrows) as in the primary graft (orange arrows)

From the 4 graft failures in the primary DMEK graft, 2 eyes had also secondary graft failure (without allograft rejection)

after re-DMEK

Influence of host intrinsic properties and/or comorbidities ?

• Feasibility Graft detachment & graft failure successfully managed

• Clinical outcomes Satisfactory Slower visual rehabilitation consider early re-DMEK

consider postoperative CL fitting • Complications

Better anticipated since graft detachment & graft failure may recur

Conclusions