Abstract
Objective To present the outcomes of attempts to salvage total graft detachment following Descemetʼs
membrane endothelial keratoplasty (DMEK).
Methods A search of the electronic medical records of two tertiary medical centers for all
patients who underwent DMEK yielded six cases of postoperative total graft detachment
(2.54%). Graft salvage was attempted in all cases using repeated intracameral graft
staining, unfolding, and reattachment to the stroma under 20% hexafluoride gas.
Results In all cases, a free-floating totally detached graft was identified in the anterior
chamber shortly after surgery. Salvage surgery resulted in a central, well-oriented,
and fully attached graft. In three cases, the primary graft failed, and in two, the
corneas cleared at first but failed after 2 months and 1 year respectively. In one
case, the cornea remained clear during 1 year of follow-up but had a very low endothelial
cell density.
Conclusion Reattachment of fully detached DMEK graft is technically possible, but graft manipulation
during the primary and secondary operations is likely to damage the endothelial cells,
resulting in primary or early graft failure. If graft salvage is attempted, the probability
of primary or early graft failure should be discussed with the patient, and expectations
should be tempered accordingly.
Key words
cornea - DMEK - graft detachment
