Risk Factors for Repeat Descemet Membrane Endothelial Keratoplasty Graft Failure
Authors: Clara Chan, Eyal Cohen, David V. Rootman, Nizar Din, Michael Mimouni, Tanya Trinh, Larissa Gouvea, Sara Alshaker.
Disclosure Block: C. Chan: None. E. Cohen: None. D.V. Rootman: None. N. Din: None. M. Mimouni: None. T. Trinh: None. L. Gouvea: None. S. Alshaker: None.
Abstract Title: Risk Factors for Repeat Descemet Membrane Endothelial Keratoplasty Graft Failure
Purpose: To evaluate re-Descemet Membrane Endothelial Keratoplasty (DMEK) success rates and to identify risk factors for re-DMEK failure.
Study Design: Retrospective
Methods: settings:institutional. Patients and interventions:A chart review was performed, including all eyes with primary DMEK failure who underwent re-DMEK between 2013 to 2019 at the Toronto Western Hospital and the Kensington Eye Institute (Toronto, Ontario, Canada) and had at least 6 months of follow-up. Main outcome measure: predicting factors for re-DMEK outcome
Results: Out of 590 consecutive DMEK surgeries, 40 eyes (6.7%) were identified for having a secondary DMEK surgery after failure primary DMEK. Etiologies for primary DMEK were Fuchs endothelial corneal dystrophy (32.5%), pseudophakic bullous keratopathy (35%), prior failed graft (27.5%), other indications (5%). Fifty five percent of the cohort were categorized as having complicated anterior segment including 11 eyes with previous glaucoma surgery, 7 eyes post PKP, 4 eyes post DSAEK, 3 eyes had peripheral anterior synechia, 3 eyes had previous pars plana vitrectomy, 2 eyes aphakia and 1 eye each with aniridia, anterior chamber intraocular lens (IOL) and iris fixated IOL. Re-DMEK failure was documented in 12 eyes (30%) of the entire cohort. The risk factor for re-DMEK failure was the presence of complicated anterior segment (p=0.01, OR=17.0 (95% CI 1.92-150.85)), with 50% re-DMEK failure rate in this subgroup.
Conclusions: re-DMEK is a viable option for cases of primary DMEK failure, especially for eyes with FECD as indication for primary DMEK without other ocular morbidities, however, eyes categorized with complicated anterior segment, had high re-DMEK failure rates.