Top

Graefe's Archive for Clinical and Experimental Ophthalmology

Open Access 26-03-2024 | Keratoplasty | Cornea

Effects of graft detachment on the central corneal thickness after uncomplicated Descemet membrane endothelial keratoplasty

Authors: Tibor Lohmann, Sabine Baumgarten, David Kürten, Julia Prinz, Niklas Plange, Peter Walter, Matthias Fuest

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology

Abstract

Purpose

To determine if early central corneal thickness (CCT) and best-corrected visual acuity (BCVA) changes indicate graft detachment after uncomplicated Descemet membrane endothelial keratoplasty (DMEK).

Methods

In this analysis of our prospectively collected ADDA registry data (https://drks.de/search/de/trial/DRKS00027180), 45 pseudophakic eyes underwent DMEK surgery at the Department of Ophthalmology, RWTH Aachen University. Anterior segment optical coherence tomography (AS-OCT), the presence of stromal ripples on the posterior corneal surface, and BCVA measurements were assessed prior to, 1 day, 1 week, 1 month, and 6 months after surgery.

Results

Eyes were categorized into three groups: no graft detachment (group 1) (20/45; 44.4%), < 1/3 graft detachment (group 2) (14/45; 31.1%), ≥ 1/3 graft detachment followed by rebubbling (group 3) (11/45; 24.4%). Eyes in group 3 had a greater CCT prior to (746.8 ± 95.8 µm vs. 665.0 ± 74.4 µm, P = 0.041), and 1 week (666.8 ± 119.5 µm vs. 556.5 ± 56.8 µm, P = 0.001) after DMEK compared to group 1. By 1 month, CCT in all groups aligned. Comparing prior to and 1 week after DMEK, none of the eyes in group 1 had an increase in CCT, while the CCT increased in 25.0% of eyes in group 2 and 22.2% in group 3. In group 1, 90.0% had a CCT of < 600 µm 1 week after DMEK, compared to only 50.0% in group 2 and 36.4% in group 3. In group 1, 90.0% (18/20) had an improved BCVA 1 week after DMEK, while in groups 2 and 3, 86.7% (12/14) and 18.2% (2/11) improved, respectively. One patient in group 3 showed posterior stromal ripples 1 day and 1 week after DMEK.

Conclusion

If 1 week after uncomplicated DMEK CCT is < 600 µm and has decreased from before surgery, BCVA has improved, and there are no posterior stromal ripples, a graft detachment ≥ 1/3 and the need for rebubbling are very unlikely. In all other cases, meticulous slit-lamp and OCT inspection of the peripheral graft for detachments should be advised.

Deng SX, Lee WB, Hammersmith KM, Kuo AN, Li JY, Shen JF, Weikert MP, Shtein RM (2018) Descemet membrane endothelial keratoplasty: safety and outcomes: a report by the American Academy of Ophthalmology. Ophthalmology 125:295–310. https://doi.org/10.1016/j.ophtha.2017.08.015CrossRefPubMed

Anshu A, Price MO, Tan DT, Price FW Jr (2012) Endothelial keratoplasty: a revolution in evolution. Surv Ophthalmol 57:236–252. https://doi.org/10.1016/j.survophthal.2011.10.005CrossRefPubMed

Hamzaoglu EC, Straiko MD, Mayko ZM, Sáles CS, Terry MA (2015) The first 100 eyes of standardized Descemet stripping automated endothelial keratoplasty versus standardized Descemet membrane endothelial keratoplasty. Ophthalmology 122:2193–2199. https://doi.org/10.1016/j.ophtha.2015.07.003CrossRefPubMed

Flockerzi E, Turner C, Seitz B, Collaborators GSG (2023) Descemet’s membrane endothelial keratoplasty is the predominant keratoplasty procedure in Germany since 2016: a report of the DOG-section cornea and its keratoplasty registry. Br J Ophthalmol. https://doi.org/10.1136/bjo-2022-323162CrossRefPubMed

Melles GR, Ong TS, Ververs B, van der Wees J (2006) Descemet membrane endothelial keratoplasty (DMEK). Cornea 25:987–990. https://doi.org/10.1097/01.ico.0000248385.16896.34CrossRefPubMed

Dapena I, Moutsouris K, Droutsas K, Ham L, van Dijk K, Melles GR (2011) Standardized “no-touch” technique for Descemet membrane endothelial keratoplasty. Arch Ophthalmol (Chicago, Ill: 1960) 129:88–94. https://doi.org/10.1001/archophthalmol.2010.334CrossRef

Brissette A, Conlon R, Teichman JC, Yeung S, Ziai S, Baig K (2015) Evaluation of a new technique for preparation of endothelial grafts for Descemet membrane endothelial keratoplasty. Cornea 34:557–559. https://doi.org/10.1097/ico.0000000000000394CrossRefPubMed

Yoeruek E, Bayyoud T, Hofmann J, Bartz-Schmidt KU (2013) Novel maneuver facilitating Descemet membrane unfolding in the anterior chamber. Cornea 32:370–373. https://doi.org/10.1097/ICO.0b013e318254fa06CrossRefPubMed

Monnereau C, Quilendrino R, Dapena I, Liarakos VS, Alfonso JF, Arnalich-Montiel F, Böhnke M, Pereira NC, Dirisamer M, Parker J, Droutsas K, Geerling G, Gerten G, Hashemi H, Kobayashi A, Naveiras M, Oganesyan O, Orduña Domingo E, Priglinger S, Stodulka P, Torrano Silva J Jr, Venzano D, Vetter JM, Yiu E, Melles GR (2014) Multicenter study of Descemet membrane endothelial keratoplasty: first case series of 18 surgeons. JAMA ophthalmology 132:1192–1198. https://doi.org/10.1001/jamaophthalmol.2014.1710CrossRefPubMed

10.

Melles GR, Ong TS, Ververs B, van der Wees J (2008) Preliminary clinical results of Descemet membrane endothelial keratoplasty. Am J Ophthalmol 145:222–227. https://doi.org/10.1016/j.ajo.2007.09.021CrossRefPubMed

11.

Maier AK, Gundlach E, Schroeter J, Klamann MK, Gonnermann J, Riechardt AI, Bertelmann E, Joussen AM, Torun N (2015) Influence of the difficulty of graft unfolding and attachment on the outcome in Descemet membrane endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol 253:895–900. https://doi.org/10.1007/s00417-015-2939-9CrossRefPubMed

12.

Fritz M, Grewing V, Gruber M, Wagner H, Zander D, Lapp T, Lang SJ, Heinzelmann-Mink S, Maier PC, Reinhard T, Wacker K (2021) Rotational alignment of corneal endothelial grafts and risk of graft detachment after Descemet membrane endothelial keratoplasty: a double-masked pseudo-randomized study. Acta Ophthalmol 99:e1334–e1339. https://doi.org/10.1111/aos.14849CrossRefPubMed

13.

Siggel R, Adler W, Stanzel TP, Cursiefen C, Heindl LM (2016) Bilateral Descemet membrane endothelial keratoplasty: analysis of clinical outcome in first and fellow eye. Cornea 35:772–777. https://doi.org/10.1097/ico.0000000000000811CrossRefPubMed

14.

Parekh M, Leon P, Ruzza A, Borroni D, Ferrari S, Ponzin D, Romano V (2018) Graft detachment and rebubbling rate in Descemet membrane endothelial keratoplasty. Surv Ophthalmol 63:245–250. https://doi.org/10.1016/j.survophthal.2017.07.003CrossRefPubMed

15.

Lohmann T, Baumgarten S, Plange N, Walter P, Fuest M (2021) Effects of uncomplicated Descemet membrane endothelial keratoplasty on the central retinal thickness. Graefes Arch Clin Exp 259:2731–2741. https://doi.org/10.1007/s00417-021-05203-2CrossRef

16.

Dunker S, Winkens B, van den Biggelaar F, Nuijts R, Kruit PJ, Dickman M (2021) Rebubbling and graft failure in Descemet membrane endothelial keratoplasty: a prospective Dutch registry study. Br J Ophthalmol. https://doi.org/10.1136/bjophthalmol-2020-317041CrossRefPubMed

17.

Kuerten D, Plange N, Koch EC, Koutsonas A, Walter P, Fuest M (2015) Central corneal thickness determination in corneal edema using ultrasound pachymetry, a Scheimpflug camera, and anterior segment OCT. Graefes Arch Clin Exp Ophthalmol 253:1105–1109. https://doi.org/10.1007/s00417-015-2998-yCrossRefPubMed

18.

Fu L, Hollick EJ (2022) Rebubbling and graft detachment in Descemet membrane endothelial keratoplasty using a standardised protocol. Eye (London, England). https://doi.org/10.1038/s41433-022-02362-2

19.

Fernández López E, Baydoun L, Gerber-Hollbach N, Dapena I, Liarakos VS, Ham L, Melles GR (2016) Rebubbling techniques for graft detachment after Descemet membrane endothelial keratoplasty. Cornea 35:759–764. https://doi.org/10.1097/ico.0000000000000829CrossRefPubMed

20.

Hesse M, Kuerten D, Walter P, Plange N, Johnen S, Fuest M (2017) The effect of air, SF6 and C3F8 on immortalized human corneal endothelial cells. Acta Ophthalmol 95:e284–e290. https://doi.org/10.1111/aos.13256CrossRefPubMed

21.

Fuest M, Mehta JS (2017) Descemet membrane splitting following deep anterior lamellar keratoplasty. JAMA Ophthalmol 135:e170656. https://doi.org/10.1001/jamaophthalmol.2017.0656CrossRefPubMed

22.

Coco G, Levis HJ, Borgia A, Romano D, Pagano L, Virgili G, Kaye SB, Romano V (2023) Posterior stromal ripples increase risk of Descemet’s membrane endothelial keratoplasty graft detachment worsening over time. Acta Ophthalmol 101:e205–e214. https://doi.org/10.1111/aos.15250CrossRefPubMed

23.

GermanClinicalTrialsRegister. https://drks.de/search/de/trial/DRKS00027180. Accessed 10 Dec 2023

24.

Dirisamer M, van Dijk K, Dapena I, Ham L, Oganes O, Frank LE, Melles GR (2012) Prevention and management of graft detachment in Descemet membrane endothelial keratoplasty. Arch Ophthalmol (Chicago, Ill: 1960) 130:280–291. https://doi.org/10.1001/archophthalmol.2011.343CrossRef

25.

Guerra FP, Anshu A, Price MO, Giebel AW, Price FW (2011) Descemet’s membrane endothelial keratoplasty: prospective study of 1-year visual outcomes, graft survival, and endothelial cell loss. Ophthalmology 118:2368–2373. https://doi.org/10.1016/j.ophtha.2011.06.002CrossRefPubMed

26.

Muijzer MB, Noordmans HJ, Delbeke H, Dickman MM, Nuijts R, Dunker S, Imhof SM, Wisse RPL (2023) Establishing a biomarker for the prediction of short-term graft detachment after Descemet membrane endothelial keratoplasty. Cornea 42:204–210. https://doi.org/10.1097/ico.0000000000003006CrossRefPubMed

27.

Guindolet D, Disegni H, Martin GC, Azar G, Hardy S, Cochereau I, Gabison EE (2023) Predictive factors of graft detachment and rebubbling after Descemet membrane endothelial keratoplasty. Int Ophthalmol 43:1511–1521. https://doi.org/10.1007/s10792-022-02547-4CrossRefPubMed

28.

Yeh RY, Quilendrino R, Musa FU, Liarakos VS, Dapena I, Melles GR (2013) Predictive value of optical coherence tomography in graft attachment after Descemet’s membrane endothelial keratoplasty. Ophthalmology 120:240–245. https://doi.org/10.1016/j.ophtha.2012.08.011CrossRefPubMed

29.

Dirisamer M, Dapena I, Ham L, van Dijk K, Oganes O, Frank LE, van der Wees J, Melles GR (2011) Patterns of corneal endothelialization and corneal clearance after Descemet membrane endothelial keratoplasty for fuchs endothelial dystrophy. Am J Ophthalmol 152:543-555.e541. https://doi.org/10.1016/j.ajo.2011.03.031CrossRefPubMed

30.

Friedrich M, Son HS, Khoramnia R, Auffarth GU, Augustin VA (2023) Late central graft detachment due to double endothelial layer after repeat Descemet membrane endothelial keratoplasty. Am J Ophthalmol Case Rep 32:101883. https://doi.org/10.1016/j.ajoc.2023.101883CrossRefPubMedPubMedCentral

31.

Kramer N, Unterlauft JD, Girbardt C (2023) The need of rebubbling in case of small graft detachments after Descemet membrane endothelial keratoplasty (DMEK). Eur J Ophthalmol 33:1347–1353. https://doi.org/10.1177/11206721221146579CrossRefPubMed

32.

Vasiliauskaitė I, Oellerich S, Ham L, Dapena I, Baydoun L, van Dijk K, Melles GRJ (2020) Descemet membrane endothelial keratoplasty: ten-year graft survival and clinical outcomes. Am J Ophthalmol 217:114–120. https://doi.org/10.1016/j.ajo.2020.04.005CrossRefPubMed

33.

Schaub F, Enders P, Snijders K, Schrittenlocher S, Siebelmann S, Heindl LM, Bachmann BO, Cursiefen C (2017) One-year outcome after Descemet membrane endothelial keratoplasty (DMEK) comparing sulfur hexafluoride (SF(6)) 20% versus 100% air for anterior chamber tamponade. Br J Ophthalmol 101:902–908. https://doi.org/10.1136/bjophthalmol-2016-309653CrossRefPubMed

Title: Effects of graft detachment on the central corneal thickness after uncomplicated Descemet membrane endothelial keratoplasty
Authors: Tibor Lohmann
Sabine Baumgarten
David Kürten
Julia Prinz
Niklas Plange
Peter Walter
Matthias Fuest
Publication date: 26-03-2024
Publisher: Springer Berlin Heidelberg
Keyword: Keratoplasty
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-024-06452-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of graft detachment on the central corneal thickness after uncomplicated Descemet membrane endothelial keratoplasty

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content