Three-quarter DMEK in eyes with glaucoma draining devices to avoid secondary graft failure.

PURPOSE: To present a case series of a modified three-quarter Descemet's membrane endothelial keratoplasty (3/4-DMEK) technique to treat pseudophakic bullous keratopathy in the presence of a glaucoma drainage device (GDD) tube in the anterior chamber by reducing the risk of donor endothelial damage due to absence of donor endothelial cells overlying the GGD tube area. METHODS: In this prospective case series, four eyes of three patients with stable glaucoma underwent 3/4-DMEK surgery for pseudophakic bullous keratopathy after GDD insertion. The patients were followed up to 24 ± 2.5 months postoperatively. RESULTS: No intraoperative or postoperative complications were noted. The average central endothelial cell density (ECD) was 1093 ± 74 cells/mm2 at 12 months postoperatively, corresponding to an ECD decrease of 58 (±6)% as compared to preoperative values. Average best-corrected visual acuity increased from finger counting before surgery to 20/60 (logMar 0.5) at 12 months after 3/4-DMEK and remained stable up to 24 months postoperatively. All corneas remained clear at the last available follow-up. CONCLUSION: This case series demonstrates the technical feasibility of 3/4-DMEK in eyes with pseudophakic bullous keratopathy in the presence of a GDD tube. The absence of a donor DM and donor cells above the silicone tube excludes direct tube contact with the graft. Longer term studies are needed to show the effect of this modified graft pattern and dimensions on transplant survival.

Five Keratoplasties From One Donor Cornea.

PURPOSE: To describe the feasibility of same-day, consecutive use of a single donor cornea in 5 patients with corneal pathology, who required anterior lamellar and endothelial keratoplasties. METHODS: Descemet membrane (DM) with endothelium was completely stripped from a single corneoscleral button and punched out from the endothelial side with a circular, standard punch. Using a custom-made punch for linear cutting of DM, we obtained 4 quarter-grafts (Q-graft). The denuded and punched-out corneal stroma was transplanted in 1 patient with keratoconus, using the big-bubble deep anterior lamellar keratoplasty (DALK) technique. The 4 DM Q-grafts were consecutively transplanted to 4 patients with Fuchs dystrophy using the quarter Descemet membrane endothelial keratoplasty (Q-DMEK or 1/4 DMEK) technique. RESULTS: All surgical procedures were performed successfully during 1 surgical session. No intraoperative or postoperative complications requiring intervention were observed. Six months after surgery, the decimal best-corrected visual acuity achieved was 0.66 after DALK and 0.95 ± 0.1 (range, 0.8-1.0) in the 4 Q-DMEK cases; the endothelial cell density was 1680 ± 254 cells/mm (range, 1492-2039 cells/mm). Six months postoperatively, all corneas were clear. CONCLUSIONS: In this limited series, we demonstrate that 1 donor cornea can be successfully used for 5 recipients. Although performing DALK and Q-DMEK on a single day is technically challenging, it is feasible and can dramatically reduce the shortage and the cost of corneal tissue. Strict case selection is necessary. Further study on this approach is required.