Favourable outcome after late reorientation of an upside-down Descemet Membrane Endothelial Keratoplasty (DMEK) graft: a case report
Abstract Background Clinical outcome after successful reorientation of an upside-down implanted DMEK (Descemet Membrane Endothelial Keratoplasty) graft 4 weeks after initial transplantation. Case presentation A 71-year-old woman presented with Fuchs’ endothelial corneal dystrophy for DMEK. After ini...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-07-01
|
| Series: | BMC Ophthalmology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12886-019-1181-3 |
| _version_ | 1818610901743304704 |
|---|---|
| author | Siegfried Mariacher Martina Mariacher Karl Thomas Boden Peter Szurman Kai Januschowski |
| author_facet | Siegfried Mariacher Martina Mariacher Karl Thomas Boden Peter Szurman Kai Januschowski |
| author_sort | Siegfried Mariacher |
| collection | DOAJ |
| description | Abstract Background Clinical outcome after successful reorientation of an upside-down implanted DMEK (Descemet Membrane Endothelial Keratoplasty) graft 4 weeks after initial transplantation. Case presentation A 71-year-old woman presented with Fuchs’ endothelial corneal dystrophy for DMEK. After initial DMEK the donor graft was fully attached and well centred during intracameral gas filling. When the gas bubble was fully resorbed the graft started to detach. Therefore, two intracameral gas injections were consecutively performed. During the second re-bubbling, an upside-down orientation was observed and so the graft was flipped, centred, re-attached and finally stabilized by an intracameral gas bubble. Three weeks after reorientation slit lamp examinations showed a well centred and attached graft, endothelial cells that started functioning and a patient’s visual acuity of 20/40. Visual acuity increased to a 20/32 vision in the observed eye three months later and further improved to 20/20 6 months after reorientation and stayed stable between 20/32 and 20/20 during the remaining 15 months of follow-up, with a clear and well-attached graft. Conclusion Reorientation of an upside down DMEK graft was successful even 4 weeks after initial DMEK. Visual recovery and endothelial cell count increase were stepwise noticed during the first 6 months and 15 months after reorientation, respectively. Finally a favourable outcome with 20/32 to 20/20 vision at least 6 months after graft reorientation was achieved. Therefore, restoring full graft function could last several weeks or even months following (late) reorientation of an upside-down DMEK graft. |
| first_indexed | 2024-12-16T15:21:48Z |
| format | Article |
| id | doaj.art-d9317adf998e42dfa10bd956a57c13d2 |
| institution | Directory Open Access Journal |
| issn | 1471-2415 |
| language | English |
| last_indexed | 2024-12-16T15:21:48Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Ophthalmology |
| spelling | doaj.art-d9317adf998e42dfa10bd956a57c13d22022-12-21T22:26:38ZengBMCBMC Ophthalmology1471-24152019-07-011911510.1186/s12886-019-1181-3Favourable outcome after late reorientation of an upside-down Descemet Membrane Endothelial Keratoplasty (DMEK) graft: a case reportSiegfried Mariacher0Martina Mariacher1Karl Thomas Boden2Peter Szurman3Kai Januschowski4Knappschaft Eye Clinic, Knappschaft Hospital Saar GmbHKnappschaft Eye Clinic, Knappschaft Hospital Saar GmbHKnappschaft Eye Clinic, Knappschaft Hospital Saar GmbHKnappschaft Eye Clinic, Knappschaft Hospital Saar GmbHKnappschaft Eye Clinic, Knappschaft Hospital Saar GmbHAbstract Background Clinical outcome after successful reorientation of an upside-down implanted DMEK (Descemet Membrane Endothelial Keratoplasty) graft 4 weeks after initial transplantation. Case presentation A 71-year-old woman presented with Fuchs’ endothelial corneal dystrophy for DMEK. After initial DMEK the donor graft was fully attached and well centred during intracameral gas filling. When the gas bubble was fully resorbed the graft started to detach. Therefore, two intracameral gas injections were consecutively performed. During the second re-bubbling, an upside-down orientation was observed and so the graft was flipped, centred, re-attached and finally stabilized by an intracameral gas bubble. Three weeks after reorientation slit lamp examinations showed a well centred and attached graft, endothelial cells that started functioning and a patient’s visual acuity of 20/40. Visual acuity increased to a 20/32 vision in the observed eye three months later and further improved to 20/20 6 months after reorientation and stayed stable between 20/32 and 20/20 during the remaining 15 months of follow-up, with a clear and well-attached graft. Conclusion Reorientation of an upside down DMEK graft was successful even 4 weeks after initial DMEK. Visual recovery and endothelial cell count increase were stepwise noticed during the first 6 months and 15 months after reorientation, respectively. Finally a favourable outcome with 20/32 to 20/20 vision at least 6 months after graft reorientation was achieved. Therefore, restoring full graft function could last several weeks or even months following (late) reorientation of an upside-down DMEK graft.http://link.springer.com/article/10.1186/s12886-019-1181-3DMEKUpside-downInversionGraft failureRe-bubblingGraft reorientation procedure |
| spellingShingle | Siegfried Mariacher Martina Mariacher Karl Thomas Boden Peter Szurman Kai Januschowski Favourable outcome after late reorientation of an upside-down Descemet Membrane Endothelial Keratoplasty (DMEK) graft: a case report BMC Ophthalmology DMEK Upside-down Inversion Graft failure Re-bubbling Graft reorientation procedure |
| title | Favourable outcome after late reorientation of an upside-down Descemet Membrane Endothelial Keratoplasty (DMEK) graft: a case report |
| title_full | Favourable outcome after late reorientation of an upside-down Descemet Membrane Endothelial Keratoplasty (DMEK) graft: a case report |
| title_fullStr | Favourable outcome after late reorientation of an upside-down Descemet Membrane Endothelial Keratoplasty (DMEK) graft: a case report |
| title_full_unstemmed | Favourable outcome after late reorientation of an upside-down Descemet Membrane Endothelial Keratoplasty (DMEK) graft: a case report |
| title_short | Favourable outcome after late reorientation of an upside-down Descemet Membrane Endothelial Keratoplasty (DMEK) graft: a case report |
| title_sort | favourable outcome after late reorientation of an upside down descemet membrane endothelial keratoplasty dmek graft a case report |
| topic | DMEK Upside-down Inversion Graft failure Re-bubbling Graft reorientation procedure |
| url | http://link.springer.com/article/10.1186/s12886-019-1181-3 |
| work_keys_str_mv | AT siegfriedmariacher favourableoutcomeafterlatereorientationofanupsidedowndescemetmembraneendothelialkeratoplastydmekgraftacasereport AT martinamariacher favourableoutcomeafterlatereorientationofanupsidedowndescemetmembraneendothelialkeratoplastydmekgraftacasereport AT karlthomasboden favourableoutcomeafterlatereorientationofanupsidedowndescemetmembraneendothelialkeratoplastydmekgraftacasereport AT peterszurman favourableoutcomeafterlatereorientationofanupsidedowndescemetmembraneendothelialkeratoplastydmekgraftacasereport AT kaijanuschowski favourableoutcomeafterlatereorientationofanupsidedowndescemetmembraneendothelialkeratoplastydmekgraftacasereport |