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Postoperative Repositioning of Inverted Descemet Membrane Endothelial Keratoplasty Grafts

Dragnea, Diana C. MD*,†; Nobacht, Siamak MD; Gericke, Adrian MD§; Parker, Jack MD, PhD¶,‖; Oellerich, Silke PhD*; Ham, Lisanne PhD*,†,**; Melles, Gerrit R.J. MD, PhD*,†,‖,**

doi: 10.1097/ICO.0000000000001796
Clinical Science

Purpose: To present 4 cases of postoperative repositioning of inverted grafts after Descemet membrane endothelial keratoplasty (DMEK).

Methods: Retrospective case reports of 4 patients presenting with subtotal to total graft detachment after DMEK, most probably owing to upside-down graft positioning. Graft repositioning was performed 1 to 14 days after initial DMEK surgery. In 3 cases (cases 1, 3, and 4), repositioning was performed without removing the graft from the anterior chamber (AC), whereas for case 2, the graft had to be removed from the AC to attain correct graft orientation.

Results: In all 4 cases, the initially upside-down DMEK grafts could be successfully repositioned postoperatively. Three cases showed complete graft attachment after graft repositioning with clear corneas until the last available follow-up. One case manifested a persistent central detachment with central corneal edema, eventually requiring re-DMEK. Endothelial cell density decreased from 2800 cells/mm2 preoperatively to 2373 cells/mm2 at 2 years postoperatively for case 1 and from 2600 to 600 cells/mm2 at 6 months postoperatively for case 2. Case 3 showed a clear cornea until the last available follow-up at 1 year postoperatively.

Conclusions: In cases of upside-down grafts after DMEK, attempting to reposition the graft, with or without removing the graft from the AC, may be a cost- and tissue-efficient alternative before converting to re-DMEK.

*Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands;

Melles Cornea Clinic Rotterdam, The Netherlands;

Department of Opthalmology, Radboud University Medical Center, The Netherlands;

§Department of Ophthalmology, University Medical Center Mainz, Germany;

Parker Cornea, Birmingham, AL;

NIIOS-USA, San Diego; and

**Amnitrans EyeBank Rotterdam, The Netherlands.

Correspondence: Gerrit R.J. Melles, MD, PhD, Netherlands Institute for Innovative Ocular Surgery, Laan op Zuid 88, 3071AA Rotterdam, The Netherlands (e-mail:

G. R.J. Melles is a consultant for DORC International/Dutch Ophthalmic USA and SurgiCube International. J. Parker is a consultant for DORC International/Dutch Ophthalmic USA and Ziemer Ophthalmic Systems. The remaining authors have no conflict of interest to disclose.

Received July 25, 2018

Accepted September 09, 2018

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