Off-Centered Descemet Membrane Endothelial Keratoplasty Grafts: Impact and Resolution

Area of Science:

• Ophthalmology
• Corneal Surgery
• Endothelial Keratoplasty

Background:

• Descemet membrane endothelial keratoplasty (DMEK) is a leading surgical treatment for corneal endothelial dysfunction.
• Graft decentration, a potential complication, may influence surgical outcomes and visual recovery.

Purpose of the Study:

• To evaluate the clinical outcomes of off-centered Descemet membrane endothelial keratoplasty (DMEK) grafts.
• To compare the results of DMEK with graft decentration to descemetorhexis outcomes.

Main Methods:

• Retrospective case series of 8 patients undergoing DMEK between June 2022 and July 2023.
• Analysis of postoperative graft decentration, defined as the gap between the graft and descemetorhexis edge.
• Assessment of visual acuity, central corneal thickness, and graft adherence.

Main Results:

• The average gap between the descemetorhexis edge and DMEK graft was 911.2 μm.
• Focal peripheral edema overlying the gap resolved in all cases within a median of 3 months.
• Best-corrected visual acuity significantly improved to 0.01 logMAR at 12 months (P = 0.003), and central corneal thickness decreased (P = 0.05).
• Larger gaps showed a trend toward longer edema resolution (P = 0.06) but did not impact final visual acuity (P = 0.75).

Conclusions:

• Decentered DMEK grafts result in focal stromal edema that resolves spontaneously over time.
• Graft decentration does not significantly compromise final visual acuity outcomes in DMEK.
• The surgical technique and graft positioning are crucial for optimal outcomes in endothelial keratoplasty.