Endoilluminator-assisted Descemet membrane endothelial keratoplasty and endoilluminator-assisted pre-Descemet endothelial keratoplasty

Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand

Purpose

To investigate the medium-term clinical outcomes and risk factors for primary graft failure after Descemet membrane endothelial keratoplasty (DMEK) in Thai patients.

Patients and Methods

This is a single-center retrospective cohort study. Sixty-two eyes of 62 patients who underwent DMEK at Ramathibodi Hospital, Bangkok, Thailand, with a minimum of 24-month follow-up were recruited. Preoperative donor and recipient characteristics, intraoperative data, and postoperative outcomes including best-corrected visual acuity (BCVA), graft clarity, endothelial cell density (ECD), central corneal thickness (CCT), and complications were evaluated at 1, 3, 6, 12, and 24 months after surgery.

Results

The mean age of the patients was 67.2 ± 9.9 years, and 52% were female. The mean follow-up time was 37.5 ± 11.0 months. The most common indications for DMEK were Fuchs' endothelial corneal dystrophy (FECD) (53.2%) and pseudophakic bullous keratopathy (PBK) (17.7%). Nearly half of patients had triple-DMEK. The median preoperative BCVA was 20/400. Postoperative BCVA of ≥ 20/40 was reached in 37.1% and of ≥ 20/20 in 6.5% after 1 month which increased to 54.8% and 17.7% after 3 months; and to 67.7% and 27.4% after 24 months. Endothelial cell loss (ECL) at 3, 6, 12, and 24 months was 30.5%, 33.8%, 44.4%, and 45.9%, respectively. Graft diameter was the single factor, showing a significant relationship with postoperative ECD. Most frequent postoperative complications included graft detachment (22.6%), increased IOP/glaucoma (17.7%), and primary graft failure (16.1%). In univariate analysis, death-to-operation time and the diagnosis of PBK were significantly associated with the occurrence of primary graft failure.

Conclusion

DMEK is a safe, effective, and feasible treatment for endothelial failure in Asian eyes. Careful case selection, use of relatively fresh donor tissues, and appropriate surgical techniques can prevent primary graft failure and facilitate optimal outcomes following surgery.

"Mouse Sign" on Optical Coherence Tomography of Detached Endothelial Graft Indicates Graft Inversion

Purpose:

To report the mouse-like configuration of detached endothelial keratoplasty graft observed on optical coherence tomographic imaging after pre-Descemet's endothelial keratoplasty (PDEK).

Case Report:

Three eyes of 3 patients who underwent PDEK and had graft detachment in the initial postoperative period of <2 weeks were examined. Fourier domain optical coherence tomography was performed in all eyes. All 3 patients had partial graft detachment with the detached region involving the central and inferior cornea. One end of the graft formed a thick convex scroll detaching outward, downward, and upward, and the other end was attached to the edematous cornea forming the ‘mouse’ configuration. The graft was inverted, and rebubbling failed in all 3 eyes. Graft exchange was required.

Conclusion:

Mouse sign in OCT imaging indicates the possibility of an inverted graft and predicts unsuccessful rebubbling. Graft exchange is required in such eyes.