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Descemet Membrane Endothelial Keratoplasty in Eyes with Glaucoma Implants

Heindl, Ludwig M.*†; Koch, Konrad R.*; Bucher, Franziska*; Hos, Deniz*; Steven, Philipp*†; Koch, Hans-Reinhard*†; Cursiefen, Claus*†

doi: 10.1097/OPX.0b013e31829d8e64
CLINICAL COMMUNICATIONS: Clinical Cases

Purpose This study aims to analyze the feasibility of Descemet membrane endothelial keratoplasty (DMEK) in the management of corneal endothelial decompensation in eyes with glaucoma implants.

Case Report A 62-year-old male with bullous keratopathy after trabeculectomy and Baerveldt shunt implantation for contusion glaucoma of the right eye (case 1) underwent surgical tube trimming with a DMEK procedure. A 54-year-old male with Descemet stripping automated endothelial keratoplasty (DSAEK) failure and dislocation in the presence of an Ahmed glaucoma valve and an artificial iris in the right eye (case 2) was treated by removal of the DSAEK graft and subsequent DMEK procedure. In both eyes, the DMEK graft could be successfully inserted, unfolded, positioned in front of the glaucoma tube, and attached to the host stroma by air injection into the anterior chamber. Postoperatively, both corneas cleared with complete graft attachment and stable glaucoma tube position. After 3 days, peripheral graft detachment occurred in case 1 and was managed successfully with one intracameral air reinjection. Case 2 revealed intraocular pressure (IOP) elevation up to 30 mm Hg in the immediate postoperative period, treated successfully by antiglaucoma medications. Within 1-year follow-up, visual acuity improved from hand movements to 20/63 and 20/32, respectively; endothelial cell density decreased by 36% and 42%, respectively; and the IOP ranged between 7 and 14 mm Hg in both cases without treatment.

Conclusions Descemet membrane endothelial keratoplasty seems to be feasible in the management of corneal endothelial decompensation in eyes with glaucoma implants. Graft attachment, IOP, and endothelial cell density should be followed up closely.

*MD

PhD

Department of Ophthalmology, University of Cologne, Cologne (LMH, KRK, FB, DH, PS, CC); and Hochkreuzklinik Eye Hospital, Bonn (H-RK), Germany.

Ludwig M. Heindl, MD, PhD, Department of Ophthalmology, University Hospital of Cologne, Kerpener Strasse 62 50924 Cologne, Germany e-mail: ludwig.heindl@uk-koeln.de

© 2013 American Academy of Optometry