Long-term Follow-up and Complications of Stripping Descemet Membrane Without Placement of Graft in Eyes With Fuchs Endothelial Dystrophy

Purpose: The aim of this study was to describe the clinical course in Fuchs dystrophy where the central Descemet membrane was removed and not replaced with donor tissue. Methods: Three patients with Fuchs endothelial dystrophy had descemetorhexis without endothelial keratoplasty. Results: In each case, endothelial cells repopulated the majority of the descemetorhexis area within about 4 months, but 1 localized area failed to repopulate, which led to persistent focal edema and associated symptoms. In each case, the area that was successfully repopulated with endothelium was smooth, whereas the area that did not repopulate successfully had an irregular surface, which seemed to be caused by localized stromal roughening from the descemetorhexis. In case 2, Descemet membrane endothelial keratoplasty was performed without removing the repopulated endothelial cells, and the graft did not stick despite repeated rebubbling, so it was replaced 3 months later. The regraft adhered after stripping off the repopulated endothelial cells before inserting the new graft. Conclusions: Despite considerable surgeon experience and care exercised while performing the descemetorhexis, some roughening of the posterior stroma seemed to impede repopulation by host endothelial cells in a localized area and led to chronic corneal inflammation when a graft was not implanted. The prolonged corneal edema and associated symptoms resulted in a less desirable postoperative course compared with the rapid corneal clearing regularly achieved with Descemet membrane endothelial keratoplasty.