Descemet Membrane Endothelial Keratoplasty with Irregular-Edged Graft: A Salvage Method for Large Radial Graft Tears

Abstract

Large radial tears of donor Descemet membrane (DM) during the preparation of Descemet membrane endothelial keratoplasty (DMEK)grafts can make the trephination stage impossible because of small graft diameter. This results in irregular-edged grafts. In this study, wereport two pseudophakic bullous keratopathy patients who underwent DMEK surgery with irregular-edged Descemet membrane (DM)grafts. Main outcome measures were preoperative and postoperative 1-, 3-, and 6-month best corrected visual acuity (BCVA), endothelialcell density (ECD) and central corneal thickness (CCT). Intraoperative and early postoperative complications were also evaluated. Bothirregular-edged grafts were successfully implanted into the anterior chamber, unfolded, and attached to the posterior corneal stroma.Patients’ BCVA at 6 months was 1.0 (Snellen equivalent: 20/20) and 0.6 (Snellen equivalent: 20/32) respectively. Decrease in ECD atthe last visit was 27% and 25%. CCT decreased from 723 μm and 850 μm to 530 μm and 523 μm, respectively. No intraoperativecomplications occurred except for the large radial Descemet membrane graft tears that developed during donor DM stripping. Noneof the cases needed a rebubbling procedure postoperatively. We have demonstrated that irregular-edged DM grafts can be successfullyimplanted for DMEK surgery with good clinical outcomes.