Late Post-Operative Detatchment of Graft after DMEK (Descemet Membrane Endothelial Keratoplasty): A Video Presentation
To demonstrate the surgical technique of Descemet's Membrane Endothelial Keratoplasty and management of late graft detachment
Summary of Content
In this decade with the advent of DSEK and DMEK, penetrating keratoplasty is being replaced more and more with endothelial keratoplasty as only the posterior diseased part of the cornea is replaced giving better results with low complication rates. Endothelial keratoplasty (EK) represents the selective replacement of dysfunctional endothelium with healthy donor endothelium and is the preferred treatment for any cornea which has diseased endothelium and relatively normal overlying corneal tissue. EK has evolved over the past 10 years from our very difficult, time consuming procedure of Deep Lamellar Endothelial Keratoplasty (DLEK) to its current form of DSEK and DMEK.Common Indications for EK are Aphakic or Pseudophakic Bullous Keratopathy(PBK), Fuchs Endothelial Dystrophy, Endothelial graft rejection. In India approximately 10 million cataract surgeries are performed annually. Incidence of PBK is approximately 0.5%.This implies that 50,000 patients would require EK annually.DMEK is the most recent method of managing patients with endothelial decomposition and Descemets disease and more physiological method in contrast to DSEK. In the recipient's eye scoring of Descemets membrane is done with reverse Sinskey hook. Descemet is stripped from the cornea and taken out. If too much epithelial edema is there, the epithelium is removed for better visibility. The endothelial side of donor cornea is stained with trypan blue dye and Descemet membrane is stripped off from the cornea. This layer is carefully lifted and loaded in an injector (IOL or ICL). Corneal tunnel is made and AC maintainer is placed. The donor tissue is injected slowly in the AC With careful manipulations. The donor tissue is unfolded such that the endothelial side is down. This is done by taking into account that the donor tissue always unfolds with endothelial side out. Once properly oriented air tamponade of the donor tissue is done and the cornea is adhered to the recipient corneaDMEK has the advantage that there is no interface haze, low incidence of graft rejection, early visual rehabilitation, less chances of graft dislocation, minimal astigmatism, minimal chances of postop glaucoma and minimal suture related complications. The common complications of DMEK are reverse graft placement, primary graft failure, graft dislocation and rejection. ConclusionDMEK is a preferred technique in corneal endothelial dysfunction. Late graft detachment is an unusual complication of DMEK which can be successfully managed by rebubbling.
[ Keyword ]
DMEK / Endothelial / Keratoplasty / Fuch's / Graft rejection
[ Conflict of Interest ]