Repeat Descemet Membrane Endothelial Keratoplasty for Failed Primary Descemet Membrane Endothelial Keratoplasty at a Referral Center for Keratoplasty in Spain: DIMOEK Study
Autor: | Nuno Moura-Coelho, Merce Morral, Jose L. Güell, Felicidad Manero, Daniel Elies, Nicolás Amich, Oscar Gris |
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Rok vydání: | 2020 |
Předmět: |
Graft Rejection
Male Reoperation medicine.medical_specialty Visual acuity Graft failure genetic structures Descemet membrane Visual Acuity Cell Count 03 medical and health sciences Postoperative Complications 0302 clinical medicine Primary outcome Ophthalmology Humans Medicine Treatment Failure Referral and Consultation Aged Retrospective Studies 030304 developmental biology High rate 0303 health sciences business.industry Graft Survival Endothelial Cells Retrospective cohort study Corneal Endothelial Cell Loss Middle Aged Tissue Donors eye diseases Spain Descemet Stripping Endothelial Keratoplasty 030221 ophthalmology & optometry Referral center Female medicine.symptom business |
Zdroj: | American Journal of Ophthalmology. 215:49-55 |
ISSN: | 0002-9394 |
DOI: | 10.1016/j.ajo.2020.03.015 |
Popis: | Purpose To analyze the clinical results of repeat Descemet membrane endothelial keratoplasty (re-DMEK) for failed primary DMEK graft at a referral center for keratoplasty in Spain. Design Retrospective, interventional, comparative case series. Methods From a single-center, single-surgeon series of 189 consecutive DMEK surgeries, 14 (7.41%) were re-DMEK eyes. The primary outcome was best-corrected visual acuity change (ΔBCVA, logarithm of minimal angle of resolution [logMAR]) from baseline (before first DMEK) to last follow-up. Secondary outcomes were ΔBCVA from baseline at 3, 6, and 12 months postoperatively, endothelial cell loss (%ECL), rebubbling rate, and re-DMEK graft failure. Outcomes were compared with an age-matched control group of 18 successful primary DMEK eyes. Results After re-DMEK (median follow-up time 14.5 [42.5] months), mean BCVA improved from 0.55 (0.42) logMAR (Snellen 20/71 [20/53]) at baseline to 0.09 (0.26) logMAR (Snellen 20/25 [20/36]; P = .037). ΔBCVA from baseline was statistically significant at months 3 (P = .028), 6 (P = .023), and 12 (P = .012), and ΔBCVA was significant observed between months 6 and 12 (P = .028). BCVA differences between patient groups were statistically nonsignificant at 3 (P = .397), 6 (P = .468), and 12 months (P = .647). Mean %ECL in re-DMEK eyes with follow-up ≥12 months was 48.2 (15.1%), and the rebubbling rate was 28.6%; differences between groups were statistically nonsignificant for both variables (P = .580 and P = .669, respectively). Three re-DMEK eyes developed graft failure, all achieving final BCVA ≤0.30 logMAR (Snellen ≥20/40) after tertiary keratoplasty. Conclusions Repeat DMEK produces significant, continuous visual improvement after failed primary DMEK. Although visual outcomes and %ECL were comparable to primary DMEK, there was a relatively high rate of graft failure after re-DMEK. |
Databáze: | OpenAIRE |
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