Feasibility and Outcome of Descemet Membrane Endothelial Keratoplasty in Complex Anterior Segment and Vitreous Disease.

Abstract

Descemet membrane endothelial keratoplasty (DMEK) is becoming the method of choice for treating Fuchs endothelial dystrophy and pseudophakic bullous keratopathy. We investigated whether DMEK can serve as a routine procedure in endothelial decompensation even in complex preoperative situations. Of a total of 1184 DMEK surgeries, 24 consecutive eyes with endothelial decompensation and complex preoperative situations were retrospectively analyzed and divided into 5 groups: group 1: irido-corneo-endothelial syndrome (n = 3), group 2: aphakia, subluxated posterior chamber intraocular lens or anterior chamber intraocular lens (n = 6), group 3: DMEK after trabeculectomy (n = 4), group 4: DMEK with simultaneous intravitreal injection (n = 6), and group 5: DMEK after vitrectomy (n = 5). Main outcome parameters were best-corrected visual acuity, central corneal thickness, endothelial cell density, rebubbling rate, and graft failure rate. Best-corrected visual acuity (logMAR) increased from 0.98 to 0.53 (P = 0.002), 0.53 (P = 0.091), and 0.57 (P = 0.203) after 1, 3, and 6 months, respectively. Central corneal thickness decreased from 731 ± 170 to 546 ± 152 μm (P = 0.001), 514 ± 66 μm (P = 0.932), and 554 ± 98 μm (P = 0.004) after 1, 3, and 6 months, respectively. Donor endothelial cell density decreased from 2478 ± 185 to 1454 ± 193/mm² (P < 0.001), 1301 ± 298/mm² (P = 0.241), and 1374 ± 261/mm² (P = 0.213), after 1, 3, and 6 months, respectively. The rebubbling rate was 46% (11/24). Four patients (17%) had secondary graft failure. Our data provide evidence that DMEK is feasible for the treatment of endothelial decompensation in complex preoperative situations.