Abstract
BackgroundTo report two cases of Descemet Membrane Endothelial Keratoplasty (DMEK) in patients with existing scleral-fixated and iris-fixated intraocular lenses (sf-IOL and if-IOL, respectively).Case presentationDMEK procedures were performed on a 49-year-old woman with a pre-existing sf-IOL (case 1) and a 69-year-old woman with a pre-existing if-IOL (case 2) in order to treat secondary corneal edema due to pseudophakic bullous keratopathy. Visual acuity, refractive error, intraocular pressure, slit lamp examination, pachymetry measurements and endothelial cell density (ECD) were considered and repeated during follow-ups.Both cases had no intraoperative complications. At postoperative day 1 graft centration and complete attachment were noted. The IOL positions were unchanged in comparison to their preoperative positions. In case 1, visual acuity improved from 1/15 at 1 meter preoperative to 20/200 within one week and to 20/63 within 12 weeks of follow up. In case 2, visual acuity improved from counting fingers at 1 meter preoperative to 20/200 within one week and to 20/100 within 12 weeks of follow-up. In case 2 a partial graft dislocation was observed at postoperative day twenty. Complete graft re-apposition was achieved by rebubbling procedure performed with intracameral air injection.ConclusionsDMEK surgery in the treatment of pseudophakic bullous keratopathy in the presence of sf-IOL and if-IOL can successfully be performed. These eyes are at increased risk of IOL dislocation into the vitreous cavity during DMEK surgery.
Highlights
To report two cases of Descemet Membrane Endothelial Keratoplasty (DMEK) in patients with existing scleral-fixated and iris-fixated intraocular lenses.Case presentation: DMEK procedures were performed on a 49-year-old woman with a pre-existing sf-IOL and a 69-year-old woman with a pre-existing Iris-fixated intraocular lens (if-IOL) in order to treat secondary corneal edema due to pseudophakic bullous keratopathy
DMEK surgery in the treatment of pseudophakic bullous keratopathy in the presence of sf-IOL and if-IOL can successfully be performed. These eyes are at increased risk of IOL dislocation into the vitreous cavity during DMEK surgery
Lamellar keratoplasty has been shown to offer a promising alternative to penetrating keratoplasty (PK) and has become a popular procedure for the management of corneal endothelial diseases (CED) [2-5]
Summary
Several techniques and different IOL types to treat aphakia have been described. During the surgery two critical steps, first descemetorhexis under air visualization and second final fixation under air pressurization, pose an increased risk of IOL dislocation especially in cases having if-IOL and sf-IOL implants. When these two steps are preformed there is a risk that the air bubble could exert pressure on the IOL, endangering its stability, with possible malpositioning or even dislocation into the vitreous chamber. Unfolding was achieved with simultaneous digital pressure in the equatorial region and tapping of the corneal surface It is an especially helpful maneuver in eyes with a deep anterior chamber as in postvitrectomy eyes [11]. Further studies with a larger series and longer follow-up are required to quantify the complication rates of DMEK in eyes with sf-IOLs and if-IOLs
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