Ocular Microbiology and Immunology Group
Back to OMIG Main Page

< Previous | 2025 Agenda and Abstracts | Next >

2025 OMIG Abstract

Descemet’s Membrane Anterior Keratoplasty (DMAK) Outcomes in Limbal Stem Cell Deficiency Assessed with Anterior Segment Optical Coherence Tomography-A Case Series

Neslihan Dilruba Koseoglu¹, Pedram Hamrah<sup>1,2

1</sup>Center for Translational Ocular Immunology, Tufts Medical Center, Boston, Massachusetts;
²New England Eye Center, Tufts Medical Center, Boston, Massachusetts

Purpose: Descemet’s Membrane Anterior Keratoplasty (DMAK) is a newly introduced surgical intervention in which a Descemet’s membrane is transplanted onto the ocular surface. We present the clinical outcomes of a series of patients, including anterior segment optical coherence tomography (AS-OCT).

Methods: A retrospective chart review of electronic medical records was conducted for patients who underwent DMAK between June 2023 and June 2025. Four patients diagnosed with limbal stem cell deficiency (LSCD) who underwent DMAK were identified. The diagnoses prompting surgery, best-corrected visual acuity (BCVA) before and after surgery, and AS-OCT findings are documented for each patient.

Results:
Patient 1: A 68-year-old female diagnosed with LSCD and neurotrophic keratopathy (NK) stage 1, due to graft-versus-host disease, presenting with a vision of 20/70. At the time of DMAK surgery, there was subepithelial corneal scarring, pannus extending between 10-5 clock hours leading to severe surface irregularity, and nasal symblepharon. At 7 months post-surgery, the patient reported a decrease in her vision and was diagnosed with significant cataracts (BCVA:20/400). After cataract removal, 8 months post-DMAK, her vision improved back to the baseline BCVA of 20/70 with a clear central cornea and good anatomical adhesion of the graft without revascularization as observed on AS-OCT.
Patient 2: An 81-year-old female with a history of NK and LSCD stages 1-2, as a result of repeated penetrating keratoplasties (PKP), presenting with surface irregularities including an extensive pannus and a stromal herpetic keratitis scar. Baseline BCVA was 20/200 at the time of DMAK. She was followed for 14 months, with good graft adhesion on AS-OCT without recurrence of neovascularization. Final BCVA was restricted at 20/200 due to her previous corneal scar and an epiretinal membrane.
Patient 3: A 60-year-old male with a history of failed PKP and NK stages 1-2, with LSCD resulting with multiple areas of superficial neovascularization at the graft-host junction and a pannus extending to corneal apex. The patient underwent DMAK with superficial keratectomy with a preoperative BCVA of 20/400. At his last follow up, 6 months post-surgery, BCVA was stable at 20/400 and AS-OCT showed good adhesion of the graft with no recurrence of epithelial defects or neovascularization.
Patient 4: A 19-year-old female with a diagnosis of aniridic LSCD, presenting with 360 degrees of pannus extending to her visual axis causing a highly irregular corneal surface and central corneal opacification. DMAK was performed with a baseline BCVA of 20/200. However, as a result of the torn graft encountered during the first surgery, after 8 months a repeat DMAK was performed due to revascularization observed in the area without a graft. At her last follow up visit, 7 months after the second DMAK, AS-OCT revealed good anatomical adhesion without recurrence of central neovascularization however her BCVA remained at 20/200 due to significant stromal scarring.

Conclusions: DMAK may offer a promising approach for corneal rehabilitation in patients with LSCD particularly when the disease can be managed with surface reconstruction before considering more invasive methods, and graft adhesion can be successfully monitored with AS-OCT.