Friedrich Maximilian, Son Hyeck-Soo, Khoramnia Ramin, Auffarth Gerd Uwe, Augustin Victor Aristide
Department of Ophthalmology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Am J Ophthalmol Case Rep. 2023 Jul 3;32:101883. doi: 10.1016/j.ajoc.2023.101883. eCollection 2023 Dec.
To report late central graft detachment after repeat Descemet membrane endothelial keratoplasty (DMEK) without visual reduction.
A 71-year-old patient with Fuchs' endothelial corneal dystrophy received a DMEK in his left eye. At 11 month post-operatively, a subtotal graft detachment was noted. Due to increasing corneal edema with vision loss, the first DMEK was removed and a repeat-DMEK was performed. At four months post repeat-DMEK, the graft was fully adherent to the posterior stroma. There was no significant corneal edema, and the best corrected visual acuity was 20/25. At 16-months after repeat-DMEK, a central graft detachment was noted, but there was no concurrent corneal edema or any loss of visual acuity. The mean density of the central endothelial cells was measured at 842 cells/mm. Given the lack of corneal edema, visual reduction or subjective visual complaint, the graft detachment was followed-up for up to 20-months post repeat-DMEK with no further intervention, where the central cornea remained clear.
To our knowledge, this is the first report of a central repeat-DMEK graft detachment that occurred 16 months after surgery despite initial attachment. Interestingly, there was no concurrent corneal edema or vision reduction. We describe a potential mechanism for clear central cornea in the presence of a central graft detachment after repeat-DMEK.
报告重复进行Descemet膜内皮角膜移植术（DMEK）后发生的晚期中央移植物脱离，但视力未下降。
一名71岁患有Fuchs内皮角膜营养不良的患者接受了左眼DMEK手术。术后11个月，发现移植物部分脱离。由于角膜水肿加重并导致视力丧失，首次DMEK移植物被移除并再次进行DMEK手术。再次DMEK术后4个月，移植物完全附着于后基质。角膜无明显水肿，最佳矫正视力为20/25。再次DMEK术后16个月，发现中央移植物脱离，但同时无角膜水肿或视力下降。中央内皮细胞的平均密度测量为842个细胞/mm²。鉴于无角膜水肿、视力下降或主观视觉不适，在再次DMEK术后对移植物脱离进行了长达20个月的随访，未进行进一步干预，但中央角膜仍保持清晰。
据我们所知，这是第一例关于重复DMEK术后16个月发生中央移植物脱离的报告，尽管最初移植物已附着。有趣的是，同时无角膜水肿或视力下降。我们描述了重复DMEK术后中央移植物脱离但中央角膜保持清晰的潜在机制。
