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

Publication History

Received: 19 January 2021

Accepted: 20 May 2021

Article published online:
26 July 2021

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