Eventual Endothelial Failure After Initial Corneal Clearing After a Detached Endothelial Graft in Fuchs Dystrophy

Purpose: To report a case of eventual corneal endothelial cell failure after spontaneous resolution of corneal edema after failed Descemet membrane endothelial keratoplasty (DMEK). Methods: Retrospective case report. Results: A 56-year-old man with Fuchs endothelial corneal dystrophy underwent cataract and DMEK surgery in the left eye. The transplanted DMEK graft detached in the early postoperative period and formed a peripheral scroll. Despite graft detachment, corneal edema resolved with endothelial cell repopulation of the central cornea. The patient's uncorrected visual acuity 5 months after surgery was 20/25. However, by 7 months after this spontaneous improvement, the patient started to complain of worsening vision. At 2.5 years, recurrent corneal edema became clinically apparent, and no endothelial cells were visible by specular microscopy in the central cornea. Conclusions: This case suggests that spontaneous healing of a large central Descemet membrane defect significantly diminishes the peripheral endothelial cell reserves and can lead to imminent bullous keratopathy. If there is any potential of corneal endothelial cells to regenerate after surgical removal of central Descemet membrane in Fuchs dystrophy, it is likely very limited.