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Identifying causes for poor visual outcome after DSEK/DSAEK following secondary DMEK in the same eye

Session Details

Session Title: Cornea

Session Date/Time: Sunday 17/02/2013 | 08:30-11:00

Paper Time: 10:28

Venue: Hall 2

First Author: : J.Parker USA

Co Author(s): :    M. Dirisamer   M. Naveiras   V. Liarakos   L. Ham   K. van Dijk   G. Melles

Abstract Details


To identify causes of reduced visual acuity after Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK), and to determine if such eyes can be successfully ‘repaired’ with a secondary Descemet membrane endothelial keratoplasty (DMEK).


Non-randomized, prospective clinical study, at a tertiary referral center.


Twelve eyes of twelve patients, that underwent secondary DMEK to manage poor visual outcome after initial DSEK/DSAEK, were evaluated with biomicroscopy, Pentacam imaging, and specular and confocal microscopy, before and at 1, 3 and 6 months after DMEK.


Four causes of reduced optical quality of the transplanted host cornea could be identified in DSEK/DSAEK: five eyes (42%) showed large host-Descemet remnants within the visual axis during surgery; six eyes (50%) irregular graft thickness; six eyes subtle ‘stromal waves’; and nine eyes (75%) high reflectivity at the donor-to-host interface. After DMEK graft replacement, all corneas cleared and achieved a best corrected visual acuity of ≥20/25 (≥0.8), except for one with a partial Descemet graft detachment. Pachymetry values decreased from 670 (±112) µm before, to 517 (±57) µm after secondary DMEK. Higher order aberrations (Coma and Trefoil) at the posterior surface tended to be lower (P=0.07) in DMEK grafts than in DSEK/DSAEK grafts.


Host-Descemet remnants at the donor-to-host interface, interface reflectivity, graft thickness irregularity and donor stromal contraction, may contribute to poor visual outcome after DSEK/DSAEK, without causing permanent host corneal damage, since in most cases complete visual recovery could be achieved by performing a secondary DMEK.

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