Clinical outcome after Descemet membrane endothelial keratoplasty in vitrectomized eyes

Abstract

Purpose The aim of the present study was to evaluate the clinical outcome after Descemet membrane endothelial keratoplasty (DMEK) in eyes with previous vitrectomy. Patients and methods This is a retrospective review of medical records and surgical videos of all DMEK cases in vitrectomized eyes (total or anterior vitrectomy) that were done at Alexandria Main University Hospital, Alexandria, Egypt, between January 2015 and November 2019. The primary outcome measure was the improvement in best-corrected visual acuity. Secondary outcome measures were unfolding time and technique, endothelial cell loss, and rebubbling rate. Results A total of 18 vitrectomized eyes of 18 patients with bullous keratopathy were included in this study. Follow-up duration ranged from 6 to 53 months, with a mean of 23.8±15.2 months. At the end of the follow-up, the best-corrected visual acuity improved from 1.9±0.5 log MAR units to 0.7±0.4 log MAR units. The mean endothelial cell density was 1136.6±204.4 cells/mm2, representing 53% loss of the mean preoperative donor endothelial cells (2388.3±114.8 cells/mm2). The mean graft unfolding time was 13.7±5.4 min. A total of 11 (61%) eyes needed rebubbling owing to postoperative Descemet membrane detachment. Conclusion DMEK is an effective surgical modality for treatment of bullous keratopathy in vitrectomized eyes. Restoration of corneal clarity and significant visual improvement were possible in all patients, despite the need for complex surgical steps, prolonged surgical time, and the increased rebubbling rate.

Keywords

• descemet
• ’s membrane
• descemet membrane endothelial keratoplasty
• fuchs’
• endothelial dystrophy
• pseudophakic bullous keratopathy
• vitrectomy