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Failed Descemet‘s Membrane Endothelial Keratoplasty (DMEK) Grafts - A Clinicopathologic Analysis -

Failed Descemet‘s Membrane Endothelial Keratoplasty (DMEK) Grafts - A Clinicopathologic Analysis -. L. M. Heindl, MD, C. Hofmann-Rummelt, U. Schlötzer-Schrehardt, PhD, F. E. Kruse, MD, C. Cursiefen, MD. Department of Ophthalmology and Eye Hospital, University Erlangen-Nürnberg, Germany.

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Failed Descemet‘s Membrane Endothelial Keratoplasty (DMEK) Grafts - A Clinicopathologic Analysis -

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  1. Failed Descemet‘s Membrane Endothelial Keratoplasty (DMEK) Grafts- A Clinicopathologic Analysis - L. M. Heindl, MD, C. Hofmann-Rummelt, U. Schlötzer-Schrehardt, PhD, F. E. Kruse, MD, C. Cursiefen, MD Department of Ophthalmology and Eye Hospital, University Erlangen-Nürnberg, Germany Chairman: Prof. F.E. Kruse, MD We have no financial interests or relationships to disclose.

  2. Background Descemet‘s Membrane Endothelial Keratoplasty (DMEK) is a newsurgicalalternative to standard full-thickness penetrating keratoplasty (PK) for the treatment of corneal endothelial disorders (~40% of all keratoplasties performed).

  3. Purpose To describe the clinicopathologic findings in failed Descemet’s membrane endothelial keratoplasty (DMEK) grafts.

  4. Patients and Methods • Retrospective interventional case series • Three consecutive patients with three DMEK failures undergoing secondary penetrating keratoplasty • Light and electron microscopic analysis

  5. Clinical Data of DMEK Failures ECD = Endothelial cell density (cells/mm²); F = Female; PBK = Pseudophakic bullous keratopathy; Fuchs = Fuchs’ endothelial dystrophy; DMEK = Descemet’s membrane endothelial keratoplasty

  6. Histopathologic Findings / Case 3 HE, × 12.5 HE, × 400 HE, × 400 HE, × 200 Stromal fibroblasts above detached Descemet’s membrane Endothelial cell showing fibroblastic transformation Posterior collagenous layer

  7. Histopathologic Results • Endothelial cell count: • 1.3 ± 1.5 cells / 8 HPF (range, 0 - 3 cells / 8 HPF) • Posterior collagenous layer: 1 / 3 • Chronic stromal inflammation: 1 / 3 • Interface fibrosis: 0 / 3 • Epithelial ingrowth: 0 / 3 • Retained Descemet‘s membrane: 0 / 3 • Malpositioning of Descemet‘s membrane: 0 / 3

  8. 3 µm 5 µm 5 µm 2 µm Ultrastructural Findings / Case 3 Fibroblastic transformation of endothelial cells Attached Descemet’s membrane Close connection between Descemet’s membrane and stroma Stromal fibroblast within the layer gap of detached Descemet’s membrane

  9. Conclusion Descemet membrane endothelial keratoplasty (DMEK)failuresare mostly primary due to the loss and alteration ofendothelial cells. Other contributings factors may include retrocorneal membrane formation and chronic stromal inflammation.

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