1. 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

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

3. 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

4. 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

5. Results BCVA: Improved in all eyes in which re- DMEK was successful
BCVA 20/25 (0.8) at 6-12 months: % 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

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

7. 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 ?

8. 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