Implantation of a trifocal IOL in highly myopic eyes with low IOL power (0.0 to 10.0 D) provided satisfactory short-term visual and refractive outcomes; however, results were not as good as those obtained in eyes with higher dioptric IOL power.

PurposeTo evaluate if repeat Descemet membrane endothelial keratoplasty (DMEK) is appropriate to achieve functional improvements in patients with corneal decompensation from secondary graft failure after primary DMEK.MethodsThis is a retrospective monocentric cohort study including 13 eyes of 13 patients with repeat DMEK for corneal decompensation following primary DMEK. Eyes with primary DMEK only and comparable preoperative corrected distance visual acuity (CDVA) served as control. Main outcome parameter was CDVA. Secondary outcome measures were central corneal thickness (CCT), endothelial cell density, and rebubbling rate (RR).ResultsThe average time interval (±SD) between primary and secondary DMEK was 12.5±6 months. Preoperative CDVA (logMAR) was 1.97±0.90 in the repeat DMEK group and 1.38±0.92 in the primary DMEK group. At 6 months, both groups showed significant improvement in visual acuity (repeat DMEK group, 0.49±0.35, P<0.01 and primary DMEK group, 0.40±0.36, P<0.01). CDVA did not differ significantly between both groups at all time points examined (1, 3, and 6 months postoperatively). Mean CCT values at 3 and 6 months postoperatively did not differ significantly between the two groups (P>0.05). The RR was 23% (n=3) in both groups.ConclusionRepeat DMEK is a useful therapeutic approach in the setting of corneal decompensation following primary DMEK. Functional results of repeat DMEK, visual acuity in particular, are comparable to patients with single DMEK only.

Purpose To investigate the efficacy and safety of Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following primary Descemet stripping automated endothelial keratoplasty (DSAEK). Methods This was a retrospective case series of 15 patients that underwent DMEK surgery for corneal decompensation after failed DSAEK. Main outcome parameter was corrected distance visual acuity (CDVA) after DMEK and DSAEK. Secondary outcome measures included central corneal thickness (CCT), endothelial cell density (ECD), rebubbling rate, and primary graft failure after DMEK. Explanted DSAEK grafts were evaluated by light microscopy. Results The mean (±SD) time period between DSAEK and DMEK surgery was 15±8 months (range, 6–31 months). Preoperative CDVA was 1.72±0.62 (logMAR). After DMEK, CDVA improved significantly to 0.78±0.48 at 1 month and to 0.23±0.24 after 12 months ( P =0.022). Visual acuity data after DMEK were significantly better compared to preoperative values. The average CCT after DMEK decreased significantly from 869±210 µm (preoperative) to 505±45 µm (1 month postoperative) ( P <0.001) and remained stable over 12 months. The ECD decreased from 2,589±209/mm 2 (preoperative) to 1,691±589/mm 2 (12 months postoperative). Rebubbling DMEK was required in three patients (=20%). Conclusion DMEK represents a feasible and safe procedure in achieving better functional results compared to DSAEK. Visual acuity and optical quality can be effectively reestablished after unsuccessful primary DSAEK surgery even in patients with long-standing corneal decompensation. Further investigations are required to validate the preliminary clinical findings.

am Main, Frankfurt am Main Abb. 1 8 Papillen-OCT ohne Hinweise auf eine signifikante Papillenprominenz bei gleichzeitig minimaler Nervenfaserausdünnung links Anamnese Eine 47-jährige, adipöse Patientin westeuropäischer Herkunft stellte sich mit einer seit 1 Woche bestehenden, plötzlich aufgetretenen, schmerzlosen Visusminderung am linken Auge vor. Sie gab an, dass die Sehschärfe im Tagesverlauf allerdings schwanken würde. Zusätzlich hätte sie unter dem linken Auge eine diskrete, nicht druckschmerzhafte Verhärtung bemerkt. Das rechte Auge wäre dahingegen unauffällig. Allgemeinerkrankungen würden nicht bestehen trotz eines langjährigen Zigarettenkonsums (15 "pack years").