Clinical Ophthalmology (Mar 2023)

Descemet’s Membrane Endothelial Keratoplasty for Corneal Endothelial Failure Secondary to Three Types of Phakic Intraocular Lens – Retrospective Study

  • Moura-Coelho N,
  • Cunha JP,
  • Dias-Santos A,
  • Dutra-Medeiros M,
  • Papa-Vettorazzi R,
  • Manero F,
  • Güell J

Journal volume & issue
Vol. Volume 17
pp. 931 – 940

Abstract

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Nuno Moura-Coelho,1– 4 João Paulo Cunha,4,5 Arnaldo Dias-Santos,2,6 Marco Dutra-Medeiros,2,6 Renato Papa-Vettorazzi,1 Felicidad Manero,1 José Güell1,3,7 1Cornea and Refractive Surgery Unit, Instituto Microcirugía Ocular (IMO) Barcelona, Barcelona, Spain; 2Ophthalmology, Faculdade de Ciências Médicas – Universidade Nova de Lisboa (NMS|FCM-UNL), Lisbon, Portugal; 3Anterior Segment, European School for Advanced Studies in Ophthalmology (ESASO), Lugano, Switzerland; 4Ophthalmology, Escola Superior de Tecnologias da Saúde de Lisboa (ESTeSL) – Instituto Politécnico de Lisboa, Lisbon, Portugal; 5Ophthalmology, Hospital CUF Cascais, Cascais, Portugal; 6Ophthalmology, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal; 7Ophthalmology, Universidad Autónoma de Barcelona (UAB), Barcelona, SpainCorrespondence: Nuno Moura-Coelho, Email [email protected]: To analyze the outcomes of Descemet’s membrane endothelial keratoplasty (DMEK) for corneal endothelial failure secondary to phakic intraocular lens implantation (PIOL) at a reference center for corneal transplantation in Spain.Design: Retrospective, single-surgeon case series.Methods: Single-center analysis of patients who underwent DMEK for PIOL-related corneal decompensation between July 2011 and July 2020 with at least 6 months of follow-up postoperatively. Primary outcome was final best-corrected visual acuity (BCVA, logMAR) compared to pre-DMEK BCVA. Secondary outcomes analyzed included post-DMEK refractive spherical equivalent, endothelial cell loss (%ECL), and graft failure.Results: Sixteen eyes (14 patients) underwent DMEK for PIOL-related corneal decompensation. Mean (SD) time to PIOL explantation was 9.3 (5.0) years, and median (P25-P75) time between PIOL explantation and DMEK surgery was 3 (2– 4) months. Median pre-DMEK BCVA was 0.80 (1.08– 0.60) logMAR. A statistically significant improvement in BCVA was observed 1 month after DMEK (p = 0.001), and median final BCVA was 0.15 (0.0– 0.35) logMAR (p = 0.002). Mean %ECL was 55.6 (18.7) % at 2-year follow-up and 61.7 (11.7) % in eyes with over 4 years of follow-up. Two eyes required re-bubbling (12.5%), one of which ended in primary graft failure (6.2%) and one eye had late endothelial graft failure (LEGF) at 4-year follow-up (1/15 grafts, 6.7%).Conclusion: In patients with PIOL-related corneal decompensation, DMEK leads to good and clinically significant refractive and visual outcomes in the medium-long term, with a good safety profile. Prospective studies are encouraged to ascertain whether these cases are at increased risk of accelerated endothelial cell loss and LEGF.Keywords: descemet membrane endothelial keratoplasty, endothelial keratoplasty, phakic intraocular lens, corneal endothelial failure

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