Failed Descemet‘s Membrane Endothelial Keratoplasty (DMEK) Grafts - A Clinicopathologic Analysis -
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Failed Descemet‘s Membrane Endothelial Keratoplasty (DMEK) Grafts
- A Clinicopathologic Analysis - L. M. Heindl, MD, C. Hofmann-Rummelt, U. Schlötzer-Schrehardt, PhD,
F. E. Kruse, MD, C. Cursiefen, MD
Department of Ophthalmology and Eye Hospital, University Erlangen-Nürnberg, Germany
Chairman: Prof. F.E. Kruse, MD
We have no financial interests or relationships to disclose.
Background
Descemet‘s Membrane Endothelial
Keratoplasty (DMEK)
is a new surgical alternative to standard full-
thickness penetrating keratoplasty (PK) for the
treatment of corneal endothelial disorders
(~40% of all keratoplasties performed).
Purpose
To describe the clinicopathologic findings
in failed Descemet’s membrane endothelial
keratoplasty (DMEK) grafts.
Patients and Methods
- Retrospective interventional case series
- Three consecutive patients with three DMEK failures
undergoing secondary penetrating keratoplasty
- Light and electron microscopic analysis
Clinical Data of DMEK Failures
Case
No.
Age,
Gender
Preoperative Diagnosis
Primary Procedure
Donor
ECD
Re-
bubbling
Postoperative
Graft Position
Interval between PK and DMEK
1 70 F PBK DMEK 2909 1 Persistent
partial detachment
5 months
2 78 F Fuchs + Cataract
Triple-DMEK
2920 0 Complete detachment
1 month
3 70 F PBK DMEK 2454 1 Complete
(re-)attachment
5 months
ECD = Endothelial cell density (cells/mm²); F = Female; PBK = Pseudophakic bullous keratopathy; Fuchs = Fuchs’ endothelial dystrophy; DMEK = Descemet’s membrane endothelial keratoplasty
Histopathologic Findings / Case 3
HE, × 200HE, × 400HE, × 400
HE, × 12.5
Stromal fibroblasts above detached Descemet’s membrane
Endothelial cell showing fibroblastic transformation
Posterior collagenous layer
Histopathologic Results
- Endothelial cell count:
1.3 ± 1.5 cells / 8 HPF (range, 0 - 3 cells / 8
HPF)
- Posterior collagenous layer:
1 / 3
- Chronic stromal inflammation:
1 / 3
- Interface fibrosis:
0 / 3
- Epithelial ingrowth:
0 / 3
- Retained Descemet‘s membrane:
0 / 3
- Malpositioning of Descemet‘s membrane: 0 /
3
Ultrastructural Findings / Case 3
3 µm 5 µm
5 µm
Fibroblastic transformation of endothelial cells
Attached Descemet’s membrane
2 µm
Close connection between Descemet’s membrane and stroma
Stromal fibroblast within the layer gap of detached Descemet’s membrane
Conclusion
Descemet membrane endothelial keratoplasty
(DMEK) failures are mostly primary due to the
loss and alteration of endothelial cells.
Other contributings factors may include
retrocorneal membrane formation and
chronic stromal inflammation.