Descemet Membrane Endothelial Keratoplasty for Corneal Decompensation Secondary to Phakic Intraocular Lenses.

Ester Fernández López,Cristina Peris Martínez

doi:10.1155/2019/2038232

Abstract

Purpose To describe the surgical technique and clinical outcomes of bilensectomy (pIOL explant and phacoemulsification), followed by DMEK performed for bullous keratopathy secondary to pIOL. Methods Seven eyes of seven patients, who developed corneal decompensation after pIOL implantation, underwent bilensectomy followed by DMEK in a two-step procedure. Main outcome measures included uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), refraction, endothelial cell density (ECD) at 1, 3, 6, and 12 months, and intraoperative and postoperative complications. Results DMEK was performed at a mean time of 9.83 ± 8.23 months after bilensectomy. BCVA (log MAR) improved in all eyes, increasing from 1.11 ± 0.78 preoperatively to 0.54 ± 0.21, 0.28 ± 0.23, 0.21 ± 0.21, and 0.17 ± 0.17 at 1, 3, 6, and 12 months after DMEK. One year after surgery, mean spherical equivalent and cylinder were −0.70 ± 0.92 D and −1.50 ± 0.54 D, respectively. ECD decreased by 62 ± 4%, 69 ± 4%, 74 ± 4%, and 77 ± 3% at 1, 3, 6, and 12 months after DMEK. There was one case of primary graft failure and no other postoperative complications. Conclusions The two-step technique bilensectomy followed by DMEK is a feasible technique for the management of bullous keratopathy secondary to pIOL, providing a fast visual recovery with good visual and refractive results.

Highlights

Phakic intraocular lens implant is a well-established technique for the correction of moderate to high refractive errors, providing high quality of vision while preserving the corneal thickness. [1,2,3,4] In the past decades, there has been a continuous development in pIOL designs and surgical technique, some postoperative complications may be encountered [5, 6] and their explantation might be necessary, especially with the first pIOL designs or an inadequate anatomy of the anterior chamber
While Fuchs dystrophy and pseudophakic bullous keratopathy continue to be the main indications for Descemet membrane endothelial keratoplasty (DMEK), technique standardization [10] and increased surgical experience have increased the spectrum of disorders suitable for DMEK such as failed corneal grafts, eyes with previous glaucoma surgeries, or vitrectomized eyes [11, 12]
We describe a case series of patients with corneal decompensation secondary to different types of pIOLs managed with a two-step procedure bilensectomy, followed by DMEK

Summary

Introduction

Phakic intraocular lens (pIOL) implant is a well-established technique for the correction of moderate to high refractive errors, providing high quality of vision while preserving the corneal thickness. [1,2,3,4] In the past decades, there has been a continuous development in pIOL designs and surgical technique, some postoperative complications may be encountered [5, 6] and their explantation might be necessary, especially with the first pIOL designs or an inadequate anatomy of the anterior chamber. In a large multicentric retrospective study of 240 explanted pIOL, the second main reason for pIOL explant after cataract formation was endothelial cell loss [7] being up to 15.97% of angle-supported pIOLs and 8.33% of irisfixated pIOLs of the 240 cases. Some of these eyes may present corneal decompensation, requiring a corneal transplant to restore corneal transparency. Patients who have undergone refractive surgery including pIOL implantation are a subset of patients with high visual and refractive expectations, in a way that DMEK might offer them a better postoperative outcome compared with previous keratoplasty techniques

Methods

Results

Conclusion