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Klin Monbl Augenheilkd 2021; 238(11): 1236-1239
DOI: 10.1055/a-1533-2149
Klinische Studie

Outcomes of Repair of Total Graft Detachment following Descemetʼs Membrane Endothelial Keratoplasty

Article in several languages: English | deutsch
Avital Adler 
1   Ophthalmology, Rabin Medical Center, Ophthalmology Division – Beilinson and Hasharon, Petah Tikva, Israel
2   Medicine, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
,
Eliane Rozanes
1   Ophthalmology, Rabin Medical Center, Ophthalmology Division – Beilinson and Hasharon, Petah Tikva, Israel
,
Peter Ciechanowski
3   Augenarzt und Augenchirurgie, Privatklinik – Augenzentrum Dietikon, Zürich, Schweiz
,
Yoav Nahum
1   Ophthalmology, Rabin Medical Center, Ophthalmology Division – Beilinson and Hasharon, Petah Tikva, Israel
2   Medicine, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
,
Shmuel Graffi
4   Department of Ophthalmology, Rambam Hospital, Haifa, Israel
5   Medicine, Technion Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
,
Uri Elbaz
1   Ophthalmology, Rabin Medical Center, Ophthalmology Division – Beilinson and Hasharon, Petah Tikva, Israel
2   Medicine, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
,
Irit Bahar
1   Ophthalmology, Rabin Medical Center, Ophthalmology Division – Beilinson and Hasharon, Petah Tikva, Israel
2   Medicine, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
,
Eitan Livny 
1   Ophthalmology, Rabin Medical Center, Ophthalmology Division – Beilinson and Hasharon, Petah Tikva, Israel
2   Medicine, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
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Abstract

Objective To present the outcomes of attempts to salvage total graft detachment following Descemetʼs membrane endothelial keratoplasty (DMEK).

Methods A search of the electronic medical records of two tertiary medical centers for all patients who underwent DMEK yielded six cases of postoperative total graft detachment (2.54%). Graft salvage was attempted in all cases using repeated intracameral graft staining, unfolding, and reattachment to the stroma under 20% hexafluoride gas.

Results In all cases, a free-floating totally detached graft was identified in the anterior chamber shortly after surgery. Salvage surgery resulted in a central, well-oriented, and fully attached graft. In three cases, the primary graft failed, and in two, the corneas cleared at first but failed after 2 months and 1 year respectively. In one case, the cornea remained clear during 1 year of follow-up but had a very low endothelial cell density.

Conclusion Reattachment of fully detached DMEK graft is technically possible, but graft manipulation during the primary and secondary operations is likely to damage the endothelial cells, resulting in primary or early graft failure. If graft salvage is attempted, the probability of primary or early graft failure should be discussed with the patient, and expectations should be tempered accordingly.

Key words

cornea - DMEK - graft detachment


Publication History

Received: 26 January 2021

Accepted: 16 June 2021

Article published online:
15 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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