Mini‐DMEK for focal defects of Descemet's membrane

Abstract

AbstractIntroductionDescemet Membrane Endothelial Keratoplasty (DMEK) has evolved into a standard procedure for patients with corneal endothelial diseases. Recent reports suggest that DMEK can also improve corneal edema in patients with breaks in Descemet's membrane (DM) as in acute hydrops.MethodsThis is a retrospective analysis of consecutive patients after DMEK with small grafts (Mini‐DMEK) for the treatment of defects of DM. The size of the graft in Mini‐DMEK was adapted to the size of the defect of DM.ResultsFour out of six Mini‐DMEKs were performed in patients with acute hydrops in keratoconus. One Mini‐DMEK was performed in a patient with a large central tear after DALK and one Mini‐DMEK was performed in a patient with Haab's striae in primary congenital glaucoma. Incomplete graft attachment necessitated one re‐Mini‐DMEK in a patient with acute keratoconus. Intraoperatively, unfolding and positioning of small grafts turned out to be more complex than in DMEK with grafts of normal size (≥7 mm). After successful Mini‐DMEK corneal thickness and corneal edema decreased in all patients.ConclusionMini‐DMEK is a viable treatment option for patients with ruptures or breaks of DM. Future analysis are needed for better identification of patients with defects of DM who will benefit from Mini‐DMEK.