Management of Upside-Down Descemet Membrane Endothelial Keratoplasty: A Case Series

Ahmed Shalaby Bardan; Mohamed B Goweida; Hesham F El Goweini; Christopher Sc Liu

doi:10.4103/JOCO.JOCO_102_20

Management of Upside-Down Descemet Membrane Endothelial Keratoplasty: A Case Series

J Curr Ophthalmol. 2020 Apr 30;32(2):142-148. doi: 10.4103/JOCO.JOCO_102_20. eCollection 2020 Apr-Jun.

Authors

Ahmed Shalaby Bardan^{1

2

3}, Mohamed B Goweida¹, Hesham F El Goweini¹, Christopher Sc Liu^{2

3

4}

Affiliations

¹ Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt, United Kingdom.
² Brighton and Sussex Medical School, Brighton, United Kingdom.
³ Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
⁴ Tongdean Eye Clinic, Hove, United Kingdom.

Abstract

Purpose: To present the management of upside-down Descemet membrane endothelial keratoplasty (DMEK) following combined phacoemulsification with DMEK (phaco-DMEK) in cases of Fuchs endothelial dystrophy (FED).

Methods: This is a comparative interventional case series extracted from a prospective interventional case series (clinical outcome of DMEK combined with phacoemulsification for FED). We report five cases of upside-down DMEK. Two cases of upside-down DMEK were managed with re-orientation and the other two with repeat DMEK. The 5^th case underwent an initial re-orientation and then a subsequent repeat graft. Graft re-orientation and repeat surgery were performed 9-20 days after initial phaco-DMEK. All the five cases were followed up over a 6-month period, and the following outcomes were assessed: best corrected visual acuity (BCVA), contrast sensitivity (CS), central corneal thickness, endothelial cell density (ECD), and central macular thickness.

Results: At the final 6-month postoperative follow-up, all the five cases achieved good outcomes in terms of BCVA and CS. Overall, the results were comparable to 32 control cases. One case of re-orientation and the case of re-orientation with subsequent repeat DMEK performed slightly less well than control cases in terms of postoperative ECD.

Conclusions: Re-orientation of the original DMEK scroll in cases of upside-down DMEK can be a safe and cost-effective alternative to repeat DMEK. If re-orientation does not result in corneal deturgescence, a repeat DMEK may be done subsequently.

Keywords: Descemet membrane endothelial keratoplasty; Endothelial keratoplasty; Liu vents; Moutsouris sign; Upside-down Descemet membrane endothelial keratoplasty.