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Study investigates cause of incomplete visual recovery following DMEK
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AMSTERDAM — Although descemet’s membrane endothelial keratoplasty provides the best visual outcomes of all corneal transplantation techniques, there are still a number of patients, about 40%, who do not achieve full visual recovery.
However, “the causes can always be recognized and successfully addressed,” Isabel Dapena, MD, said at the Eucornea meeting.
Isabel Dapena
In a study conducted at the NIIOS institute, 200 eyes were reviewed at 6 months for patients who had visual acuity of 20/32 or less and patients with higher visual acuity but visual complaints.
“We found that about 40%, had incomplete visual recovery, and that the causes were patient-related in about half of the cases ,” Dapena said.
Posterior segment problems such as undiagnosed maculopathy (10%) or the presence of irregular cornea or scarring due to longstanding corneal edema (8%) were the main causes of lower vision, followed by cataract or posterior capsule opacification. Patients with visual acuity of 20/25 were usually young patients with high visual demands who complained of ghost images or diplopia.
Graft-related causes were mainly graft detachment (11%) or delayed graft function (5%) such as delayed corneal clearance in spite of graft attachment.
Assessing the presence of corneal edema is the basis for targeted management of these cases, Dapena said.
“Corneal edema shows that the problem is graft-related. In these cases, endothelial cell count and OCT examination, to differentiate between graft detachment of delayed corneal clearance, should be performed,” she said.
“If corneal clearance does not occur spontaneously, rebubbling might be necessary within a few weeks or , in the worst cases, re-DMEK or DSEK can be performed after 2 to 3 months.”
Disclosure: Dapena has no relevant financial disclosures