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Descemet's membrane endothelial keratoplasty (DMEK) under previous DMEK for secondary endothelial graft failure

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Session Details

Session Title: Moderated Poster Session: Cornea

Venue: Poster Village: Pod 1

First Author: : J.Alió del Barrio SPAIN

Co Author(s): :    A. Vega   J. Alio                    

Abstract Details


To describe an alternative treatment option for secondary Descemet membrane endothelial keratoplasty (DMEK) graft failure, by using a second DMEK graft without primary graft removal (“DMEK under DMEK”).


Vissum Corporación and Universidad Miguel Hernández, Alicante, Spain.


Two consecutive patients with pseudophakic bullous keratopathy underwent an 8.25mm second DMEK under an 8.5mm failed DMEK due to previous graft rejection and subsequent secondary failure.


Corrected distance VA improved from 0.2 (decimal scale) to 0.56 (best visual potential due to pre-existing macular damage) from the first month after surgery up to the sixth month follow-up in patient 1. Patient 2 improved from hand movements to 0.1 (underlying advanced dry-AMD). In both patients, complete corneal transparency was achieved from first postoperative day. Pachymetry returned to normal values within the first month. No haze was documented either clinically or by high resolution AS-OCT, and the optical quality wasn’t affected: Strehl ratio (Osiris) of 0.112 after the first DMEK and before graft failure, and 0.147 after reDMEK.


A second DMEK graft without peeling/removing the first DMEK graft is an alternative treatment option for DMEK graft secondary failure, being this approach able to achieve a full anatomical and functional restoration of the pre-failure status. This technique allows an easier and faster second graft surgery, with less intraoperative risks.

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