Descemet Membrane Endothelial Keratoplasty (DMEK) in Previously Vitrectomized Eyes: Complications and Clinical Outcomes

Abstract

Purpose To evaluate the results and complications of Descemet membrane endothelial keratoplasty (DMEK) in previously vitrectomized eyes.

Design Retrospective study of 35 eyes that had undergone DMEK, due to Fuchs endothelial corneal dystrophy (FECD), at our department with a follow-up after 6 months postoperatively. We compared the intraoperative procedure, complications, and results of DMEK between 14 previously vitrectomized pseudophakic eyes (group 1) and a control group of 21 pseudophakic non-vitrectomized eyes (group 2).

Results The unfolding time (in minutes) was significantly longer in group 1 than in group 2 (10.5 ± 6.4 vs. 3.2 ± 1.5, p < 0.01). A single re-bubbling was needed in 8 patients in group 1 (57.1%) and in 3 patients in group 2 (14.2%) (p < 0.01). Repeated re-bubbling (≥ 1 time) was performed in only 5 patients of group 1 (35.7%). There was significant postoperative improvement in best-corrected visual acuity (BCVA, in LogMAR) in both groups (p = 0.04 in group 1 and p < 0.01 in group 2). The central corneal thickness (CCT, in µm) did not differ significantly between the two groups preoperatively (p = 0.4) or postoperatively (p = 0.1). However, the CCT decreased significantly postoperatively in both groups (p < 0.01 in both groups). The postoperative endothelial cell density (ECD in cell/mm²) was significantly lower in group 1 than in group 2 (p = 0.03).

Conclusion DMEK in previously vitrectomized eyes presents a surgical challenge, which requires special, and sometimes unpredictable, intraoperative maneuvers, but good functional and morphological results can be achieved. The use of the endothelial Descemet membrane lamellae (EDML) of older donors might be recommended to facilitate the intraoperative unfolding process.

Zusammenfassung

Ziel Evaluierung der Ergebnisse und Komplikationen der Descemet-Membran-Endothel-Keratoplastik (DMEK) in zuvor vitrektomierten Augen.

Design Retrospektive Studie von 35 Augen, die aufgrund Fuchsʼscher endothelialer Hornhautdystrophie (FECD) in unserer Abteilung einer DMEK unterzogen wurden, mit einem Follow-up von mindestens 6 Monaten postoperativ.

Ergebnisse Die Entfaltungszeit (in Minuten) war in Gruppe 1 signifikant länger als in Gruppe 2 (p < 0,01). Ein einmaliges Re-Bubbling war bei 8 Patienten in Gruppe 1 (57,1%) und bei 3 Patienten in Gruppe 2 (14,2%) erforderlich (p < 0,01). Ein wiederholtes Re-Bubbling (≥ 1 Mal) wurde nur bei 5 Patienten der Gruppe 1 (35,7%) durchgeführt. Postoperativ zeigte sich in beiden Gruppen eine signifikante Verbesserung der bestkorrigierten Sehschärfe (BCVA, in logMAR) (p = 0,04 in Gruppe 1 und p < 0,01 in Gruppe 2). Die zentrale Hornhautdicke (CCT, in µm) unterschied sich präoperativ (p = 0,4) und postoperativ (p = 0,1) nicht signifikant zwischen den beiden Gruppen. Allerdings nahm die CCT postoperativ in beiden Gruppen signifikant ab (p < 0,01 in beiden Gruppen). Die postoperative Endothelzelldichte (ECD in Zellen/mm²) war in Gruppe 1 signifikant niedriger als in Gruppe 2 (p = 0,03).

Schlussfolgerung Die DMEK in zuvor vitrektomierten Augen stellt eine chirurgische Herausforderung dar, die spezielle, manchmal unvorhersehbare, intraoperative Manöver erfordert, aber es können gute funktionelle und morphologische Ergebnisse erzielt werden. Die Verwendung der endothelialen Descemet-Membran-Lamellen (EDML) älterer Spender könnte empfohlen werden, um den intraoperativen Entfaltungsprozess zu erleichtern.

Key words

DMEK - PPV - FECD - vitrectomy

Schlüsselwörter

DMEK - PPV - FECD - Vitrektomie

Publikationsverlauf

Eingereicht: 19. Januar 2021

Angenommen: 20. Mai 2021

Artikel online veröffentlicht:
26. Juli 2021

• References

• 1 Daniel MC, Böhringer D, Lapp T. et al. Die Keratoplastik in Deutschland: systematische Auswertung der Krankenhausqualitätsberichte der Jahre 2006 bis 2017. Klin Monbl Augenheilkd 2021; 238: 288-292
• 2 Guerra FP, Anshu A, Price MO. et al. Descemetʼs membrane endothelial keratoplasty: prospective study of 1-year visual outcomes, graft survival, and endothelial cell loss. Ophthalmology 2011; 118: 2368-2373
• 3 Melles GRJ, San Ong T, Ververs B. et al. Descemet membrane endothelial keratoplasty (DMEK). Cornea 2006; 25: 987-990
• 4 Price jr. FW, Price MO. Descemetʼs stripping with endothelial keratoplasty in 200 eyes: early challenges and techniques to enhance donor adherence. J Cataract Refract Surg 2006; 32: 411-418
• 5 Asi F, Daas L, Milioti G. et al. Triple Descemet membrane endothelial keratoplasty for Haab striae with endothelial decompensation in congenital glaucoma. JCRS Online Cas Rep 2019; 7: 38-41
• 6 Allan BDS, Terry MA, Price jr. FW. et al. Corneal transplant rejection rate and severity after endothelial keratoplasty. Cornea 2007; 26: 1039-1042
• 7 Hos D, Tuac O, Schaub F. et al. Incidence and clinical course of immune reactions after Descemet membrane endothelial keratoplasty: retrospective analysis of 1000 consecutive eyes. Ophthalmology 2017; 124: 512-518
• 8 Steven P, Hos D, Heindl LM. et al. Immune reactions after DMEK, DSAEK and DALK. Klin Monbl Augenheilkd 2013; 230: 494-499
• 9 Sorkin N, Einan-Lifshitz A, Ashkenazy Z. et al. Enhancing Descemet Membrane Endothelial Keratoplasty in Postvitrectomy Eyes With the Use of Pars Plana Infusion. Cornea 2017; 36: 280-283
• 10 Saad A, Awwad ST, El Salloukh NA. et al. C-Press Technique to Facilitate Descemet Membrane Endothelial Keratoplasty Surgery in Vitrectomized Patients: A Case Series. Cornea 2019; 38: 1198-1201
• 11 Seitz B, Daas L, Bischoff-Jung M. et al. Anatomy-based DMEK Wetlab in Homburg/Saar: Novel aspects of donor preparation and host maneuvers to teach descemet membrane endothelial keratoplasty. Clin Anat 2018; 31: 16-27
• 12 Seitz B, Daas L, Flockerzi E. et al. [Descemet membrane endothelial keratoplasty DMEK – Donor and recipient step by step]. Ophthalmologe 2020; 117: 811-828
• 13 Abdin A, Daas L, Pattmöller M. et al. Negative impact of dextran in organ culture media for pre-stripped tissue preservation on DMEK (Descemet membrane endothelial keratoplasty) outcome. Graefes Arch Clin Exp Ophthalmol 2018; 256: 2135-2142
• 14 Bachmann BO, Laaser K, Cursiefen C. et al. A method to confirm correct orientation of descemet membrane during descemet membrane endothelial keratoplasty. Am J Ophthalmol 2010; 149: 922-925
• 15 Yoeruek E, Rubino G, Bayyoud T. et al. Descemet membrane endothelial keratoplasty in vitrectomized eyes: clinical results. Cornea 2015; 34: 1-5
• 16 Heinzelmann S, Hüther S, Böhringer D. et al. Influence of donor characteristics on descemet membrane endothelial keratoplasty. Cornea 2014; 33: 644-648
• 17 Mednick Z, Sorkin N, Einan-Lifshitz A. et al. Long-Term Outcomes of Descemet Membrane Endothelial Keratoplasty in Postvitrectomized Eyes With the Use of Pars Plana Infusion. Cornea 2020; 39: 457-460
• 18 Yoeruek E, Bartz-Schmidt KU. Novel Technique for Improving Graft Unfolding in Vitrectomized Eyes Using a Temporary Diaphragm in Descemet Membrane Endothelial Keratoplasty. Cornea 2018; 37: 1334-1336
• 19 Tong CM, Gerber-Hollbach N, Nieves JP. et al. “No-touch” DMEK surgical technique. Pan Am J Ophthalmol 2015; 14: 72-76
• 20 Hayashi T, Kobayashi A. Double-bubble technique in Descemet membrane endothelial keratoplasty for vitrectomized eyes: a case series. Cornea 2018; 37: 1185-1188
• 21 Schaub F, Enders P, Snijders K. et al. One-year outcome after Descemet membrane endothelial keratoplasty (DMEK) comparing sulfur hexafluoride (SF6) 20 % versus 100 % air for anterior chamber tamponade. Br J Ophthalmol 2017; 101: 902-908
• 22 Hesse M, Kuerten D, Walter P. et al. The effect of air, SF6 and C3F8 on immortalized human corneal endothelial cells. Acta Ophthalmol 2017; 95: e284
• 23 Schaub F, Simons HG, Roters S. et al. Einfluss von 20 % Schwefelhexafluorid (SF6) auf humane korneale Endothelzellen. Ophthalmologe 2016; 113: 52-57
• 24 Tsatsos M, Liarakos VS, MacGregor C. et al. Endothelial keratoplasty: is Descemet membrane endothelial keratoplasty the Holy Grail of lamellar surgery? No. Eye (Lond) 2017; 31: 1333-1336
• 25 Eguchi H, Miyamoto T, Hotta F. et al. Descemet-stripping automated endothelial keratoplasty for vitrectomized cases with traumatic aniridia and aphakic bullous keratopathy. Clin Ophthalmol 2012; 6: 1513-1518