Corneal Folds After Descemet Membrane Endothelial Keratoplasty in Congenital Hereditary Endotheial Dystrophy

Supplemental Digital Content is Available in the Text. Purpose:To report a new clinical sign of corneal folds after Descemet membrane endothelial keratoplasty (DMEK) in the eyes with congenital hereditary endothelial dystrophy (CHED).Methods:Retrospective review of cases of CHED who presented with unusual folds in recipient cornea after the DMEK procedure for CHED. Clinical outcomes including visual acuity, pachymetry, specular microscopy, anterior segment optical coherence tomography, and corneal clarity, besides postoperative complications were analyzed.Results:Fifteen eyes of 11 cases of CHED successfully underwent DMEK. Five eyes of 4 patients, mean age 17.2 +/- 5.8 years (range 10-23 years), developed unusual folds in the anterior cornea after resolution of stromal edema. Mean follow-up was 7.8 +/- 2.5 months (range 6-12 months). Mean best spectacle-corrected visual acuity improved from 0.8 +/- 0.3 LogMAR preoperatively to 0.3 +/- 0.2 LogMAR postoperatively. Corneal thickness improved from 991 +/- 65 mu m (range 924-1088 mu m) preoperatively to 595 +/- 78 mu m postoperatively (range 525-730 mu m). Average endothelial cell counts were 1708 +/- 271 cell/mm2 at the last follow-up. No intraoperative or postoperative complications were reported. The corneal folds remained unchanged during the follow-up. Comparative analysis with remaining 10 eyes did not show any significant differences.Conclusions:Cornea can present with unusual folds in the anterior stroma after successful DMEK in CHED. These folds may possibly be due to difference in collagen structure between anterior and posterior corneal stroma and needs to be studied further.