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Recurrent DMEK Failures Related to Intraocular Tutoplast
Soyang Ella Kim1, Reem Farwana, Alfonso Vasquez-Perez
1Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
Purpose:
We report a unique case of recurrent Descemet membrane endothelial keratoplasty (DMEK) failure in a 69-year-old man with a history of pseudophakic bullous keratopathy (PBK) secondary to glaucoma surgeries.
Methods:
This is a retrospective case report.
Results:
The initial PAUL glaucoma implant was relocated to the sulcus, and the original sclerostomy was plugged with Tutoplast. The patient subsequently developed PBK and underwent 3 DMEK procedures, each resulting in immediate failure, beginning inferiorly despite uneventful surgery. Subsequent assessment revealed that the Tutoplast was protruding into the anterior chamber and contacting the inferior cornea. This contact was associated with endothelial dysfunction in the transplanted DMEK, leading to complete failure. After removal of the Tutoplast and scleral patch, the patient underwent a fourth DMEK procedure, which has been successful and remains well-functioning after 9 months.
Conclusions:
This is the first published case highlighting endothelial failure associated with Tutoplast and underscores the importance of thorough preoperative assessment.
