Favourable outcome after late reorientation of an upside-down Descemet Membrane Endothelial Keratoplasty (DMEK) graft: a case report

BackgroundClinical outcome after successful reorientation of an upside-down implanted DMEK (Descemet Membrane Endothelial Keratoplasty) graft 4weeks after initial transplantation.Case presentationA 71-year-old woman presented with Fuchs' endothelial corneal dystrophy for DMEK. After initial DMEK the donor graft was fully attached and well centred during intracameral gas filling. When the gas bubble was fully resorbed the graft started to detach. Therefore, two intracameral gas injections were consecutively performed. During the second re-bubbling, an upside-down orientation was observed and so the graft was flipped, centred, re-attached and finally stabilized by an intracameral gas bubble. Three weeks after reorientation slit lamp examinations showed a well centred and attached graft, endothelial cells that started functioning and a patient's visual acuity of 20/40. Visual acuity increased to a 20/32 vision in the observed eye three months later and further improved to 20/20 6months after reorientation and stayed stable between 20/32 and 20/20 during the remaining 15months of follow-up, with a clear and well-attached graft.ConclusionReorientation of an upside down DMEK graft was successful even 4weeks after initial DMEK. Visual recovery and endothelial cell count increase were stepwise noticed during the first 6months and 15months after reorientation, respectively. Finally a favourable outcome with 20/32 to 20/20 vision at least 6months after graft reorientation was achieved. Therefore, restoring full graft function could last several weeks or even months following (late) reorientation of an upside-down DMEK graft.