Secondary DMEK following failed primary DMEK

Area of Science:

• Ophthalmology
• Corneal Surgery
• Endothelial Keratoplasty

Background:

• Descemet Membrane Endothelial Keratoplasty (DMEK) is a surgical procedure for endothelial dysfunction.
• Primary DMEK failure necessitates further intervention, such as secondary DMEK.
• Understanding reasons for primary failure is crucial for optimizing secondary procedures.

Purpose of the Study:

• To evaluate the outcomes of secondary Descemet Membrane Endothelial Keratoplasty (DMEK) in patients whose initial DMEK procedure failed.
• To identify the primary reasons for DMEK failure.
• To assess the safety and efficacy of secondary DMEK.

Main Methods:

• Retrospective review of medical records for patients undergoing secondary DMEK after primary DMEK failure.
• Analysis of reasons for primary DMEK failure, including donor endothelial cell density (ECD) and surgical complications.
• Evaluation of best-corrected visual acuity (BCVA), ECD, and complications following secondary DMEK.

Main Results:

• Ten cases of secondary DMEK were analyzed.
• Common reasons for primary failure included low donor ECD (≤2300 cells/mm²), graft detachment, and surgical difficulties.
• Median BCVA improved significantly post-secondary DMEK, with 7 out of 10 cases achieving BCVA ≥0.5.
• Mean ECD decreased by 47% at 6 months and 64% at 24 months post-secondary DMEK.

Conclusions:

• Surgical challenges (e.g., graft preparation, positioning) and low donor ECD are primary causes of DMEK failure.
• Secondary DMEK demonstrates a good safety profile.
• Reasonable visual outcomes can be achieved with secondary DMEK following primary graft failure.