Favourable outcome after late reorientation of an upside-down Descemet Membrane Endothelial Keratoplasty (DMEK) graft: a case report

Abstract

Background Clinical outcome after successful reorientation of an upside-down implanted DMEK (Descemet Membrane Endothelial Keratoplasty) graft 4 weeks after initial transplantation. Case presentation A 71-year-old woman presented with Fuchs’ endothelial corneal dystrophy for DMEK. After initial DMEK the donor graft was fully attached and well centred during intracameral gas filling. When the gas bubble was fully resorbed the graft started to detach. Therefore, two intracameral gas injections were consecutively performed. During the second re-bubbling, an upside-down orientation was observed and so the graft was flipped, centred, re-attached and finally stabilized by an intracameral gas bubble. Three weeks after reorientation slit lamp examinations showed a well centred and attached graft, endothelial cells that started functioning and a patient’s visual acuity of 20/40. Visual acuity increased to a 20/32 vision in the observed eye three months later and further improved to 20/20 6 months after reorientation and stayed stable between 20/32 and 20/20 during the remaining 15 months of follow-up, with a clear and well-attached graft. Conclusion Reorientation of an upside down DMEK graft was successful even 4 weeks after initial DMEK. Visual recovery and endothelial cell count increase were stepwise noticed during the first 6 months and 15 months after reorientation, respectively. Finally a favourable outcome with 20/32 to 20/20 vision at least 6 months after graft reorientation was achieved. Therefore, restoring full graft function could last several weeks or even months following (late) reorientation of an upside-down DMEK graft.

Long-Term Results of Postoperative Rescuing of Inverted DMEK Grafts: Two Case Reports

“…14 Similar results have been reported by other groups, with some cases requiring a re-DMEK. 15,16 In an environment with tissue scarcity, postoperative reposition of inverted grafts may result in an acceptable outcome. Our experience supports this approach as a more economical solution to cases of inverted grafts with less risk of transmissible infection through new donor tissue.…”

Gentian violet (GV) ink associated reaction in a case of preloaded Descemet membrane endothelial keratoplasty: Case report

“…This technique confers some advantages, including reduced endothelial cell loss, better visual outcomes, and low immunological rejection rates, ranging between 0% and 7%. 1 , 2 Hence, DMEK potentially confers favorable functional and anatomical outcomes. 1 , 2 …”