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