• Cornea/External Disease

    This prospective study in the March issue of the Archives of Ophthalmology investigated cases of graft detachment after Descemet membrane endothelial keratoplasty (DMEK) and discussed methods for managing detachments and reducing their incidence. The results suggest that awaiting spontaneous clearance may be helpful with partial detachments, while minor adjustments in surgical protocol, as well as careful patient selection, may further reduce the incidence of graft detachment after DMEK to four percent or less.

    The authors followed 150 consecutive eyes that underwent DMEK for 24 months after surgery. Partial or complete graft detachment was found in 36 cases (24 percent), of which 18 (12 percent) were clinically significant. All 24 eyes with a partial detachment showed spontaneous corneal clearance, and all but six of these eyes (75 percent) reached visual acuity of 20/40 or better.

    Detachments were associated with inward folds (12 eyes [33 percent]), insufficient air bubble support (7 eyes [19 percent]), upside-down graft positioning (4 eyes [11 percent]), use of plastic materials (2 eyes [6 percent]), irido-graft synechiae (1 eye [3 percent]), poor endothelial morphology (1 eye [3 percent]) and stromal irregularity under the main incision (1 eye [3 percent]).

    The authors conclude that aphakic or postvitrectomy eyes or eyes with a large-sector iridectomy, glaucoma tube, extensive corneal decompensation or tendency to have postoperative ocular hypotonia may be prone to Descemet graft detachment owing to a lack of air-bubble support and may be managed with a modified surgical technique.