Graft adhesion in descemet membrane endothelial keratoplasty dependent on size of removal of host's descemet membrane

JAMA Ophthalmol. 2014 Feb;132(2):155-61. doi: 10.1001/jamaophthalmol.2013.6222.


Importance: It is essential to devise strategies that improve graft adhesion after Descemet membrane endothelial keratoplasty (DMEK) to reduce the rebubbling rate.

Objective: To evaluate the influence of the extent of descemetorhexis on graft adhesion properties after DMEK.

Design, setting, and participants: Single-surgeon, retrospective, observational case series conducted in the Department of Ophthalmology, University of Erlangen-Nuremberg, Germany, that reviewed the medical records of 200 consecutive patients undergoing DMEK. Fifty-three eyes of 51 patients undergoing DMEK for Fuchs endothelial dystrophy fulfilling the inclusion criteria were enrolled in this study. Based on intraoperative drawings, postoperative slitlamp examination, and photographs, eyes were divided into 2 groups. The diameter of the descemetorhexis was approximately 10 mm in group A (30 eyes), resulting in a peripheral 1-mm zone of denuded stroma between the graft and the host's Descemet membrane, and approximately 6 mm in group B (23 eyes), resulting in a peripheral 1-mm zone of overlapping between the graft and the host's Descemet membrane.

Main outcomes and measures: Graft detachment rate, extent of graft detachment (in clock hours of graft's circumference), and rebubbling rate.

Results: Four days after DMEK, the graft detachment rate was 33.3% (10 of 30) in group A and 78.3% (18 of 23) in group B (P = .002). The mean (SD) extent of graft detachment was 0.6 (0.9) and 2.8 (2.5) clock hours in groups A and B, respectively (P < .001), 4 days after surgery. The rebubbling rate was 6.7% (2 of 30) and 30.4% (7 of 23) for groups A and B, respectively (P = .03).

Conclusions and relevance: A larger descemetorhexis in DMEK is correlated with better graft adhesion and lower rebubbling rates. Therefore, patients with a larger descemetorhexis require less intensive follow-up.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Corneal Stroma / metabolism
  • Descemet Membrane / metabolism*
  • Descemet Membrane / pathology*
  • Descemet Stripping Endothelial Keratoplasty*
  • Female
  • Fuchs' Endothelial Dystrophy / surgery*
  • Glucocorticoids / administration & dosage
  • Graft Rejection / prevention & control
  • Humans
  • Male
  • Middle Aged
  • Organ Size
  • Prednisolone / administration & dosage
  • Prednisolone / analogs & derivatives
  • Retrospective Studies
  • Tissue Adhesions


  • Glucocorticoids
  • prednisolone acetate
  • Prednisolone