Risk Factors for Repeat Descemet Membrane Endothelial Keratoplasty Graft Failure
| Autor: | Tanya Trinh, Gisella Santaella, Clara C. Chan, Michael Mimouni, Nir Sorkin, Eyal Cohen, David S. Rootman |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Graft Rejection
Male Reoperation Pars plana medicine.medical_specialty genetic structures medicine.medical_treatment Visual Acuity Intraocular lens Vitrectomy Aphakia Corneal Diseases 03 medical and health sciences Blister 0302 clinical medicine Recurrence Risk Factors Ophthalmology medicine Glaucoma surgery Humans Synechia Aged Retrospective Studies 030304 developmental biology Aged 80 and over 0303 health sciences business.industry Fuchs' Endothelial Dystrophy Graft Survival Corneal Transplant Corneal Endothelial Cell Loss Middle Aged medicine.disease eye diseases medicine.anatomical_structure Aniridia 030221 ophthalmology & optometry Female sense organs business Descemet Stripping Endothelial Keratoplasty Follow-Up Studies |
| Zdroj: | American Journal of Ophthalmology. 226:165-171 |
| ISSN: | 0002-9394 |
| Popis: | Purpose To evaluate repeat Descemet membrane endothelial keratoplasty (re-DMEK) success rates and to identify risk factors for re-DMEK failure. Design Retrospective case series. Methods Settings: Institutional. Patients and interventions: A chart review was performed, including all eyes with primary DMEK failure that underwent re-DMEK between 2013 and 2019 at the Toronto Western Hospital and the Kensington Eye Institute (Toronto, Ontario, Canada) and had at least 6 months of follow-up. Main outcome measure: Predicting factors for re-DMEK outcome. Results Of 590 consecutive DMEK surgeries, 40 eyes (6.7%) were identified for having a secondary DMEK surgery after primary DMEK failure. Etiologies for primary DMEK were Fuchs endothelial corneal dystrophy (32.5%), pseudophakic bullous keratopathy (35%), previous failed graft (27.5%), and other indications (5%). Fifty-five percent of the cohort were categorized as having a complicated anterior segment including 11 eyes with previous glaucoma surgery, 7 eyes post–penetrating keratoplasty, 4 eyes post–Descemet stripping automated endothelial keratoplasty, 3 eyes peripheral anterior synechia, 3 eyes previous pars plana vitrectomy, 2 eyes aphakia, and 1 eye each with aniridia, anterior chamber intraocular lens, and iris-fixated intraocular lens. Re-DMEK failure was documented in 12 eyes (30%) of the entire cohort. The risk factor for re-DMEK failure was the presence of a complicated anterior segment (P = .01, odds ratio = 17.0 [95% confidence interval: 1.92-150.85]), with 50% re-DMEK failure rate in this subgroup. Conclusion Re-DMEK is a viable option for cases of primary DMEK failure, especially for eyes with Fuchs endothelial corneal dystrophy as the indication for primary DMEK without other ocular morbidities; however, eyes categorized with a complicated anterior segment had high re-DMEK failure rates. |
| Databáze: | OpenAIRE |
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