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Progressive Corneal Clearance After a DMEK Graft Partially Folded Over on Itself in a Non-Fuchs Pseudophakic Eye

Ponce de los Ríos, Celso D. MD; Gris, Óscar MD, PhD; Elies, Daniel MD; Güell, Jose L. MD, PhD

doi: 10.1097/ICO.0000000000000195
Case Report

Purpose: The aim of this study was to report progressive corneal clearance and endothelial cell repopulation after a Descemet membrane endothelial keratoplasty graft that was partially folded over on itself in a pseudophakic patient without endothelial dystrophy.

Methods: Retrospective case report.

Results: A 75-year-old man without Fuchs dystrophy underwent cataract extraction on his right eye in 2007, and 5 years later, Descemet membrane endothelial keratoplasty was performed for pseudophakic edema in the same eye at another center. On presentation at our institution, a graft that is partially folded over on itself was observed in the right eye, leaving about 2/3 of donor endothelium correctly exposed. The graft was only attached in the lower part of the cornea. We observed progressive clearance of the entire cornea within 7 months with reendothelialization of the entire cornea. Good visual acuity was achieved, with no evidence of recurrent corneal edema.

Conclusions: Endothelial cell migration and repopulation in the presence of a folded attached endothelium graft may occur, resulting in corneal clearance and improved visual outcome. This could happen in patients with pseudophakic edema without congenital endothelial dystrophy.

Cornea Unit, Institut de Microcirugia Ocular, Universidad Autónoma de Barcelona, Cerdanyola del Vallès, Spain.

Reprints: Celso D. Ponce de los Ríos, MD, Institut de Microcirugia Ocular, Josep María Lladó No. 3, 08035 Barcelona, Spain (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received February 10, 2014

Accepted May 24, 2014

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.