Descemet membrane endothelial keratoplasty in initial cases: analysis and management of surgical complications

Abstract

Objective: To investigate causes and management of surgical complications of Descemet membrane endothelial keratoplasty (DMEK) in initial cases. Methods: A retrospective study. A total of 52 eyes of 52 patients underwent DMEK by one surgeon in Peking University Third Hospital from February 2017 to December 2019, including 17 males and 35 females, aged (66±12) years. All patients' demographic characteristics, previous surgical history, intraoperative and postoperative complications were recorded. Results: Intraoperative complications included difficulties in unfolding the graft in 6 cases (11.5%), inverted grafts in 5 cases (9.6%), grafts rushing out of the anterior chamber in 2 cases (3.8%), grafts injected behind the iris in 3 cases (5.8%) and hemorrhage in 1 case. Partial graft detachment that occurred in 28 cases (53.8%) was the most frequent postoperative complication. Rebubbling was performed in 25 cases (48.1%). Pupillary block occurred in 9 cases (17.3%) and was managed by reducing air under a slit lamp. Primary graft failure occurred in 3 cases (5.8%) and viral infection occurred in 2 cases (3.8%). Conclusions: The rate of complications of DMEK in initial cases is higher than that of Descemet stripping automated endothelial keratoplasty. Intraoperative graft inversion and postoperative graft detachment are the most common complications. It is important to select appropriate indications and discover or manage intraoperative and postoperative complications in time to reduce the incidence of complications. (Chin J Ophthalmol, 2021, 57:595-600).