Caue of Primary Donor Failure in Decemet Membrane Endothelial Keratoplaty Original Reearch Article

Purpoe To determine the caue of primary failure of donor Decemet membrane tranplant in Decemet membrane endothelial keratoplaty (DMEK). Deign Laboratory and clinical tudy. Method From a larger erie of eye that underwent DMEK for Fuch endothelial dytrophy or bullou keratopathy, 11 tranplanted cornea did not clear within the firt week after urgery. During a econdary ‘Decemet tripping endothelial keratoplaty’ procedure, the firt graft wa carefully removed and analyzed with light microcopy. For each patient, the urgical video of the initial DMEK procedure wa analyzed to determine the caue of tranplant failure. Reult With light microcopy, all but two explanted tranplant had a endothelial cell denity of 1700 cell/mm2 or higher. Three Decemet graft may have been poitioned upide down and three may have failed due to manipulation. One tranplant could not be properly attached onto the recipient poterior troma becaue of inufficient air-upport in a pot-vitrectomy eye. For four eye, no obviou caue of failure could be determined. Concluion Unexpectedly, graft failure after DMEK may not primarily reult from tiue damage during implantation and aociated endothelial cell lo. Detached graft may therefore be managed by early repoition. When the graft i attached after urgery but fail to clear, econdary urgical intervention may be potponed, becaue thee cornea may clear pontaneouly after everal week.