Intraoperative fibrin formation during Descemet membrane endothelial keratoplasty

Matthew Benage; Christopher S Sáles; Michael Korchak; Mark A Greiner; Michelle Boyce; Zachary M Mayko; Alex Bauer; Michael D Straiko; Mark A Terry

doi:10.1016/j.ajoc.2020.100686

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Intraoperative fibrin formation during Descemet membrane endothelial keratoplasty

Journal article

Open access

Peer reviewed

Intraoperative fibrin formation during Descemet membrane endothelial keratoplasty

Matthew Benage, Christopher S Sáles, Michael Korchak, Mark A Greiner, Michelle Boyce, Zachary M Mayko, Alex Bauer, Michael D Straiko and Mark A Terry

American journal of ophthalmology case reports, Vol.18, pp.100686-100686

06/2020

DOI: 10.1016/j.ajoc.2020.100686

PMCID: PMC7149398

PMID: 32292835

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Abstract

To describe Descemet membrane endothelial keratoplasty (DMEK) cases complicated by spontaneous intraoperative fibrin formation. DMEK surgeries performed at two centers using a standardized technique were reviewed retrospectively for the occurrence of intraoperative fibrin formation. Cases were assessed for recipient medical history, donor age, best spectacle-corrected visual acuity (BSCVA), intraoperative unscrolling time, 6-month endothelial cell loss (ECL), and the course of the mate donor cornea. In this review of 868 cases of standardized DMEK surgery with surgical peripheral iridotomy, 32 eyes of 29 patients (3.7%) were complicated by the formation of intraoperative fibrin formation, including 3 patients that developed fibrin in both eyes. Three of the 32 grafts failed (9.4%). None of the mate corneas transplanted (n = 27) developed complications related to fibrin. The donor age ranged from 51 to 75 years and recipient age ranged from 49 to 82 years (median, 66 years). Unscrolling time ranged from 1 to 105 min (median, 15 min). Nine eyes required one rebubble procedure. No eyes had vision-limiting comorbidities, and the 6-month BSCVA was ≥20/40 in all eyes. Six-month ECL ranged from 19% to 73% (median, 44%). We conclude that fibrin formation during DMEK surgery is an uncommon but important complication that can make graft manipulation more difficult, and may have deleterious effects on endothelial cell density and graft survival.

Fibrin

Endothelial keratoplasty

Complications

DMEK

Details

Title: Subtitle: Intraoperative fibrin formation during Descemet membrane endothelial keratoplasty
Creators: Matthew Benage - Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Christopher S Sáles - Department of Ophthalmology, Weill Cornell Medicine, New York, NY, USA
Michael Korchak - Department of Ophthalmology, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
Mark A Greiner - Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Michelle Boyce - Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Zachary M Mayko - Lions VisionGift, Portland, OR, Devers Eye Institute, Portland, OR, USA
Alex Bauer - Lions VisionGift, Portland, OR, Devers Eye Institute, Portland, OR, USA
Michael D Straiko - Lions VisionGift, Portland, OR, Devers Eye Institute, Portland, OR, USA
Mark A Terry - Lions VisionGift, Portland, OR, Devers Eye Institute, Portland, OR, USA
Resource Type: Journal article
Publication Details: American journal of ophthalmology case reports, Vol.18, pp.100686-100686
DOI: 10.1016/j.ajoc.2020.100686
PMID: 32292835
PMCID: PMC7149398
NLM abbreviation: Am J Ophthalmol Case Rep
ISSN: 2451-9936
eISSN: 2451-9936
Publisher: Elsevier Inc
Language: English
Date published: 06/2020
Academic Unit: Ophthalmology and Visual Sciences
Record Identifier: 9984111183102771

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