Off-Centered DMEK Grafts: Impact and Resolution

Purpose: The aim of this study was to assess the outcomes of off-centered Descemet membrane endothelial keratoplasty (DMEK) grafts compared to descemetorhexis. Methods: This is a retrospective case series of DMEK procedures conducted between June 2022 and July 2023 with postoperative graft decentration, characterized by a gap between the graft and descemetorhexis edge. Results: Eight eyes of 8 patients met the inclusion criteria. The average gap between the descemetorhexis edge and DMEK graft was 911.2 mm (range 306–1468). The resulting focal peripheral edema overlying the gap resolved in all cases, with a median time of 3 months. Best-corrected visual acuity improved from 0.49 (60.26) logarithm of the minimum angle of resolution to 0.01 (60.02) logarithm of the minimum angle of resolution at 12 months (P = 0.003). Central corneal thickness decreased from 646.5 (6177.8) mm to 473.7 (629.6) mm at 12 months (P = 0.05). One eye, in the overlapped area of host–donor Descemet membranes, had small peripheral partial graft detachment less than one-third of graft surface area. No eyes required graft rebubbling. A larger descemetorhexis to DMEK gap showed a trend toward longer resolution times (P = 0.06). Focal edema in the inferonasal periphery took longer to recover compared with the nasal position (P = 0.01). Larger descemetorhexis to DMEK gaps did not significantly influence the longitudinal visual acuity trend (P = 0.75). Conclusions: Decentered DMEK, characterized by a gap between the graft and descemetorhexis edge, leads to focal stromal edema that diminishes over time, with no impact on final visual acuity.