Accepted 21 February 2009. published online 13 May 2009.
Purpose
To describe spontaneous recovery of corneal transparency in 2 cases with nearly complete graft detachment after Descemet membrane endothelial keratoplasty (DMEK).
Design
Case series.
Methods
In 2 patients with Fuchs endothelial dystrophy, DMEK was performed. Through a 3-mm clear corneal tunnel incision, the recipient Descemet membrane and its endothelium was stripped off from the posterior stroma. A 9.5-mm diameter organ-cultured Descemet roll was inserted into a recipient anterior chamber, positioned onto the posterior stroma, and secured by a complete air filling of the anterior chamber for 45 minutes.
Results
At 1 month after uneventful DMEK, both transplanted corneas showed decompensation attributable to subtotal graft detachment. Unexpectedly, corneal transparency improved spontaneously, and at 3 months, both transplanted corneas had a normal pachymetry, despite persistent graft detachment. The patients' visual acuities improved to 20/50 (0.4) and 20/25 (0.8) at 3 months to 20/28 (0.7) and 20/20 (1.0), respectively at 9 months.
Conclusions
Corneal clearance in the presence of a detached DMEK graft is not consistent with the current concept of endothelial keratoplasty, which requires an (attached) donor endothelial cell layer at the recipient posterior corneal surface. Endothelial transfer, migration, regeneration, or a combination thereof from either the donor or the recipient may explain the visual recovery. These observations suggest that a review of our approach to endothelial keratoplasty and the management of corneal endothelial disorders may be warranted.
aNetherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
bMelles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
cAmnitrans EyeBank Rotterdam, Rotterdam, The Netherlands
Inquiries to Gerrit R. J. Melles, Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
ABSTRACT