Repeat DMEK for unsuccessful

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Presentation transcript:

Repeat DMEK for unsuccessful previous DMEK Isabel Dapena, Lamis Baydoun, Korine van Dijk, Vasilis Liarakos, Lisanne Ham, and Gerrit Melles Financial Disclosure: Dr. Melles is a Consultant for DORC International. Rest of the authors have no financial interests Netherlands Institute for Innovative Ocular Surgery; Melles Cornea Clinic; Amnitrans Eye Bank Rotterdam, The Netherlands

Purpose To describe: Feasibility Results Complications …of repeat-DMEK

Methods 14 Graft detachment 550 DMEK cases 17 Re-DMEK 3 Graft failure Upside down (n=3) 550 DMEK cases 17 Re-DMEK Primary indication: FED (n=15) PPBK (n=1) BK after trauma (n=1) 3 Graft failure Primary (n=1) Secondary no rejection (n=1) Secondary with

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

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

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

Complications 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) Remnants (n=1) Detachment (n=6) Significant cataract (n=1 out of 3 phakic eyes) Graft failure: Primary (n=1) Secondary (n=2) 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 ?

Conclusions 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