*Correspondence - Luis García-Onrubia: luis.garciaonrubia@gstt.nhs.uk

Objective To report the clinical outcomes of a series of cases in which localised areas of endothelial function were selectively treated with shape and position matched endothelial transplanted in a procedure we have termed Descemet’s membrane endothelial patching (DMEP).

Methods Interventional case series. Five patients presented with localised endothelial dysfunction in eyes with high-risk graft failure due either to rejection, recurrence of the focal endothelial dysfunction or because extended treatment with steroid drops was contraindicated. Endothelial grafts matching the area of dysfunction were produced to preserve healthy host cells and limit the immunological burden of new grafts. Patient demographic details, indication for surgery, preoperative and postoperative visual acuity, intraoperative and postoperative complications, and graft rejections episodes were noted.

Results Five patients were included in this cases series. Indications for DMEP were Fuchs’ heterochromic iridocyclitis (n=1), Fuchs’ endothelial dystrophy (n=2), endotheliitis (n=2). In all cases, a customised DMEP graft was used, as opposed to our standard 8.25mm circular DMEK graft size. The DMEP grafts were centred over the area of focal endothelial dysfunction. In all cases, complete graft attachment was achieved, and the corneas were cleared. Steroid drops were reduced rapidly without any episodes of graft rejection/failure reported at 1 year.

Conclusion DMEP transplants are a viable option to treat localised endothelial dysfunction. Placing non-circular, no central transplants is surgically feasible and does not appear to affect graft adhesion. Limiting the size of the transplant may limit the immunological burden of new grafts and reduce the need for extended courses of steroids.