THE TRANSPLANTATION OF DESCEMET’S MEMBRANE WITH ENDOTHELIUM IN COMPLICATED CLINICAL SITUATIONS

Abstract

The transplantation of Descemet's membrane with endothelium (DMEK) is the most efficient method of treatment of endothelium pathology. However, it is considered that at certain clinical situations DMEK is inappropriate. The purpose of study is to analyze the results of DMEK in complicated clinical situations. Materials and methods. The sampling included 14 patients (16 eyes) with pathology of endothelium of primary (19%) and secondary (81%) genesis and with concomitant alterations, including: total lack of vitreous (19%), non-posterior chamber pseudophakia (25%), presence of Ahmed drainage (25%), artificial lensiris diaphragm (12%), corneal ectasia combined with toric artiphakia (12%), penetrating scar of cornea (6%). Prior to operation, average visual acuity amounted to 0,04±0,05. The subtotal DMEK was applied to 15 eyes and in one case ¼ DMEK was implemented. In 2 cases cornea of donor had keratotomic incisions and in one case Descemetotransplant was formed from residual back layers of cornea after formation of front layer wise transplant using femtosecond laser. The results. No intra-operational complications were established. In 19% of cases a partial mismatch of transplant took place. The repeated DMEK was implemented in 1 case. The recovery of transparency of cornea and increasing of vision acuity were achieved in 94% of cases. In 6 months after operation an average central thickness of cornea amounted to 522±46 μm and density of endothelium cells in average amounted to 1541±486 kl/mm2. Conclusion. The application of DMEK in complicated situations ensures high biological and functional results and is accompanied with minimal number of complications. The procurement of expertise in endothelium surgery, it is appropriate to apply DMEK in all cases of pathology of endothelium.