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Descemet Membrane Endothelial Keratoplasty (DMEK) Graft Dislocation Into the Vitreous Cavity

Vasquez-Perez, Alfonso MD, FEBO, CertLRS*; Brennan, Nicholas MBBS, FRCOphth*; Ayoub, Tariq MBBS, FRCOphth, FEBO*; Allan, Bruce MD, FRCS, FRCOphth*; Larkin, Daniel F. P. MD, FRCPI, FRCOphth*; da Cruz, Lyndon PhD, FRCOphth

doi: 10.1097/ICO.0000000000001788
Clinical Science
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Purpose: To present our experience of Descemet stripping endothelial keratoplasty (DMEK) graft luxation into the vitreous cavity in 2 cases.

Methods: DMEK was performed in 2 patients with aphakic bullous keratopathy. The indications for keratoplasty were endothelial failure caused by chronic intermediate uveitis and glaucoma in 1 case and decompensated previous penetrating keratoplasty in the other. Both cases had enlarged pupils and had previously undergone pars plana vitrectomy. In both cases, the DMEK graft dislocated into the vitreous cavity during unfolding maneuvers and could not be retrieved during the same procedure.

Results: No signs of retinal detachment were observed during follow-up (6 months and 1 year). Although visualization of the graft was not possible on examination, B-scan confirmed the presence of the lenticule lying over the retina. One case underwent repeat DMEK, and 1 case underwent repeat penetrating keratoplasty. In 1 case, the graft was retrieved after a month and sent for histopathology. In both cases, corneal transparency and corrected visual acuity improved to full potential after the final procedure. Histopathology of the retrieved graft showed only endothelial cell loss and no fibrocellular proliferation.

Conclusions: The risk of fibrous proliferation and retinal detachment after posterior dislocation of DMEK grafts may be less than in grafts including corneal stroma, but pars plana vitrectomy and retrieval of the dislocated corneal transplant are still indicated after revision corneal transplant surgery where visual symptoms or signs of fibrotic change around the dislocated graft are evident.

*Cornea and External Diseases Service, Moorfields Eye Hospital, London, United Kingdom; and

Vitreo-Retinal Service, Moorfields Eye Hospital, London, United Kingdom.

Correspondence: Alfonso Vasquez-Perez, MD, FEBO, CertLRS, Cornea and External diseases Service, Moorfields Eye Hospital, 162 City Rd, London EC1V 2PD, United Kingdom (e-mail: alest99@gmail.com).

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

Received August 07, 2018

Accepted September 06, 2018

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