&lt;p&gt;Functional outcome of repeat Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following graft failure after primary DMEK&lt;/p&gt;

Shajari, Mehdi; Slavík-Lenčová, Anna; Kohnen, Thomas; Schmack, Ingo

doi:10.2147/opth.s192424

Cited by 14 publications

(14 citation statements)

References 15 publications

(24 reference statements)

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“…After two years, 86% of patients achieved a BCVA of at least 20/40. Agha et al 78 showed that BCVA was similar in eyes undergoing re-DMEK or primary DMEK, and BCVA improved after surgery in both groups.…”

Section: Repeat Endothelial Keratoplasty or Penetrating Keratoplasty ...mentioning

confidence: 99%

Risk Factors for Descemet Membrane Endothelial Keratoplasty Rejection: Current Perspectives- Systematic Review

Gurnani¹,

Kaur²,

Lalgudi³

et al. 2023

OPTH

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Descemet membrane endothelial keratoplasty (DMEK) is a corneal endothelial transplantation procedure with selective removal of a patient’s defective Descemet membrane and endothelium. It is replaced with a healthy donor Descemet membrane and endothelium without a stromal component. Corneal graft rejection can be at the level of epithelium, stroma as well endothelium. DMEK graft rejection is relatively less common than rejection with DSAEK or penetrating keratoplasty, and a good outcome may be achieved with prompt management. The clinical picture of DMEK rejection is usually similar to endothelial rejection in Descemet Stripping Endothelial Keratoplasty (DSEK/DSAEK), which generally manifests as pain, redness, reduction in visual acuity, stromal edema, endothelial rejection line, keratic precipitates at the back of the cornea and corneal neovascularization. However, more subtle forms of rejection or immune reactions are more common in DMEK compared to DSAEK eyes. Early clinical diagnosis, prompt intervention, and meticulous management safeguard visual acuity and graft survival in these cases. Intensive topical steroids form the mainstay in the management of DMEK rejection. Sometimes, oral or intravenous steroids or other systemic immunomodulators may be required. DMEK graft failure can be primary or secondary, and failure usually requires a second procedure in the form of repeat DMEK or DSEK or penetrating keratoplasty (PKP). A detailed literature search was performed using search engines such as Google Scholar, PubMed, and Google books, and a comprehensive review on DMEK rejection was found to be lacking. This review is a comprehensive update on the risk factors, pathophysiology, primary and secondary graft failure, recent advances in diagnosis, prevention of rejection, and updates in the management of DMEK rejection. The review also discusses the differential diagnosis of DMEK failure and rejection, prognosis, and future perspectives considering DMEK failure and rejection.

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Section: Repeat Endothelial Keratoplasty or Penetrating Keratoplasty ...mentioning

confidence: 99%

Risk Factors for Descemet Membrane Endothelial Keratoplasty Rejection: Current Perspectives- Systematic Review

Gurnani¹,

Kaur²,

Lalgudi³

et al. 2023

OPTH

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“…Bei Patienten mit rascher Reoperation, durchgeführt, um die Dauer der zentralen Hornhautdekompensation zu minimieren, entsprachen die Visusergebnisse mit sekundärer DMEK den Visusergebnissen mit primärer DMEK 16 , 29 , 30 .…”

Section: Dmek Nach Dmek/dsaekunclassified

“…In patients with rapid repeat surgery, performed to minimize the duration of central corneal decompensation, visual outcomes with secondary DMEK were equivalent to visual outcomes with primary DMEK [16,29,30].…”

Section: Dmek After Dmek/dsaekmentioning

confidence: 99%

Transplantatversagen nach PKP und DMEK: Was ist die beste Option?

Seitz

Daas

Wykrota

et al. 2022

Klin Monbl Augenheilkd

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ZusammenfassungDie Hornhauttransplantation ist das weltweit am häufigsten durchgeführte Verfahren zur Transplantation von menschlichem Gewebe. Aufgrund der großen Anzahl von Transplantationen hat sich das Versagen von Hornhauttransplantaten aus immunologischen und nicht immunologischen Gründen (z. B. Rezidiv der Grunderkrankung, hoher Augendruck, transplantierte Guttae, übertragene HSV- oder CMV-Infektion) zu einer der häufigsten Indikationen für Hornhauttransplantationen entwickelt. Die relativ neuen lamellären Transplantationstechniken haben bestimmte potenzielle Komplikationen mit sich gebracht, die zu einem Transplantatversagen führen und andere Ansätze als die perforierende Keratoplastik für eine erneute Transplantation erforderlich machen können. Andererseits bieten diese neuen lamellären Techniken auch neue Möglichkeiten zur Rettung fehlgeschlagener perforierender Transplantate, mit potenziellen Vorteilen gegenüber aufeinanderfolgenden perforierenden Keratoplastiken, wie z. B. geringere intraoperative Risiken, schnellere visuelle Rehabilitation und reduziertes Abstoßungsrisiko. Heute stellt bei gutem Heilungsverlauf der mit seinem Transplantat vor der endothelialen Dekompensation zufriedene Patient mit geringem Astigmatismus und ohne stromale Narben die optimale Voraussetzung für die DMEK nach PKP dar. Diese kann auch mit einer Phakoemulsifikation kombiniert werden (sog. Triple-DMEK). Anderenfalls erfolgt eine perforierende Re-Keratoplastik mit einem größeren Transplantat (typischerweise Excimerlaser-Re-PKP 8,5/8,6 mm), um gleichzeitig Ödem, Narben und Verkrümmung zu therapieren. Die Anamnese hat bei dieser Entscheidung Gewicht! Eine Re-DMEK bei Transplantatversagen nach DMEK und DSAEK bedarf keiner Modifikation der Standardtechnik und führt bei raschem Vorgehen zu guten Visusergebnissen. Bei eindeutiger stromaler Vernarbung nach multiplen (externen) DMEKs kann auch eine PKP zur Bereinigung der Situation erwogen werden. Bei ansonsten grundlos rezidivierenden Transplantatversagen muss man an eine herpetische oder CMV-Endotheliitis denken und nach PCR-Analyse des Kammerwasseraspirats entsprechend medikamentös therapieren.

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“…Until recently, repeated EK was mainly performed for graft failure after PKP, but the number of cases of repeated EK has gradually increased [1,6]. In particular, in the case of graft failure after primary DMEK, repeat DMEK can be performed if there are no contraindications for EK, such as stromal scarring and opaci cation [1,7]. Nevertheless, repeated DMEK can cause severe problems, such as failure to remove the previous graft.…”

Section: Introductionmentioning

confidence: 99%

Partial Descemet’s Membrane Overlap due to Previously Grafted Descemet’s Membrane Remnant: Case Report

Choi

Shim

Jun

2023

Preprint

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Background: This study aimed to describe the clinical outcomes of a patient who underwent repeated Descemet’s membrane endothelial keratoplasty (DMEK) on partially remaining Descemet’s membrane (DM) due to firm adhesion. Case presentation: A 78-year old female experienced vision fluctuations due to corneal edema after DMEK approximately 5 years ago. As scarring of the stroma was minimal, repeated DMEK was planned. The previously grafted DM was firmly attached to the posterior stroma in the inferior half area and could not be completely removed. After the donor lenticule was injected into the anterior chamber and unscrolled, room air was injected and the operation was completed. Two weeks postoperatively, focal detachment was observed at the border of the remnant DM. Focal DM detachment completely resolved without additional procedures 6 weeks postoperatively. At 5 months after surgery, the new DM was well attached, but overlap of the DM was identified on anterior segment OCT and Scheimpflug imaging. In addition, significant posterior astigmatism remained due to the overlap of the DM. Conclusions: Partially remaining DM disturbed the adhesion of the new DM at the border of the remnant. Despite the extremely thin thickness of lenticule, the overlapped DM induced significant posterior astigmatism.

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<p>Functional outcome of repeat Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following graft failure after primary DMEK</p>

Cited by 14 publications

References 15 publications

Risk Factors for Descemet Membrane Endothelial Keratoplasty Rejection: Current Perspectives- Systematic Review

Risk Factors for Descemet Membrane Endothelial Keratoplasty Rejection: Current Perspectives- Systematic Review

Transplantatversagen nach PKP und DMEK: Was ist die beste Option?

Partial Descemet’s Membrane Overlap due to Previously Grafted Descemet’s Membrane Remnant: Case Report

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