Eyes with partial graft detachment after DMEK may clear spontaneously

Arch Ophthalmol. 2011;doi:10.1001/archophthalmol.2011.343.

Awaiting spontaneous clearance may be recommended in eyes with partial graft detachment after Descemet's membrane endothelial keratoplasty, a study found.

"Minor adjustments in surgical protocol as well as careful patient selection may further reduce the incidence of graft detachment after Descemet membrane endothelial keratoplasty to 4% or less," the study authors said. "Furthermore, proper patient selection may be important: aphakic or post-vitrectomy eyes or eyes with a large-sector iridectomy, glaucoma tube, extensive corneal decompensation, or tendency to have postoperative ocular hypotonia may be prone to Descemet graft detachment owing to a lack of air-bubble support and may be managed with a modified surgical technique."

The prospective study included 150 eyes of 133 patients who underwent Descemet's membrane endothelial keratoplasty for isolated Fuchs' endothelial dystrophy. A control group included 114 eyes with well-centered and attached grafts.

Eyes were examined preoperatively and at 1, 3, 6, 9, 12, 18 and 24 months after surgery.

Graft detachments were classified into four groups. Sixteen eyes had partial detachment of one-third or less of graft surface area; eight eyes had partial detachment of more than one-third of graft surface area; four eyes had a graft positioned upside-down; and eight eyes had a free-floating Descemet's roll in the host anterior chamber.

Study results showed partial or complete graft detachment in 36 eyes (24%); in 18 of these eyes, detachment was deemed clinically significant. Spontaneous corneal clearance was observed in all 24 eyes with partial detachment; 75% of these eyes achieved visual acuity of 20/40 or better.

A reversed clearance pattern and interface spikes were identified in eyes with grafts placed upside-down. Persistent corneal edema was identified in eyes with free-floating grafts, the authors said.