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

Vito Romano1, Matteo Airaldi1,2, Davide Romano1

  • 1Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.

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|November 5, 2024
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Summary
This summary is machine-generated.

Off-centered Descemet membrane endothelial keratoplasty (DMEK) grafts can cause temporary peripheral edema that resolves without affecting final visual acuity. This study shows decentered DMEK outcomes are comparable to standard procedures.

Keywords:
DMEKalignmentcentrationcornearebubblingrhexis

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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.