Outcomes of Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes with Sutured Posterior Chamber Intraocular Lens.

Norihiro Yamada,Naoko Kato,Takahiko Hayashi,Hidenori Takahashi,Itaru Oyakawa,Toshiki Shimizu,Kentaro Yuda

doi:10.1155/2018/3127126

Abstract

Purpose To evaluate the clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) for vitrectomized eyes that underwent pars plana vitrectomy (PPV) and transscleral-sutured intraocular lens (IOL) implantation. Methods In this retrospective study, DMEK cases were reviewed from medical records and divided into two groups: the eyes after PPV and transscleral-sutured IOL implantation (vitrectomized group) and the eyes with in-the-bag IOL implantation (control group) prior to DMEK. The main outcome measures included time of graft unfolding during surgery and best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD) at 1, 3, and 6 months after the DMEK. Results Twenty-three eyes (vitrectomized group, n = 8; control group, n = 15) in 23 patients were included in this study. The unfolding time was significantly longer in the vitrectomized group than in the control group (P < 0.001). Postoperative BSCVA was worse in the vitrectomized group (0.16 ± 0.15) than in the control group (−0.06 ± 0.06; P = 0.017). The improvement in BSCVA was negatively correlated with the patients' age and frequency of previous surgeries. Conclusions Despite the longer graft unfolding time and limited visual recovery, DMEK should be applicable to vitrectomized eyes with transscleral-sutured IOL implantation.

Highlights

Descemet membrane endothelial keratoplasty (DMEK) is a new method of corneal endothelial keratoplasty introduced by Melles et al [1], which allows rapid recovery of visual acuity and minimizes immunological rejection [1,2,3,4,5]
When DMEK is performed on an eye containing a sutured intraocular lens (IOL), the IOL should be properly centered within the lens capsule, providing an intact irisIOL diaphragm
The indications of DMEK have been widely expanded to many endothelial disorders, the eyes with iris abnormalities or sutured IOL are thought to be unsuitable for DMEK [14,15,16,17,18], because the graft might be lost through the peripheral iris defect or the interspace between the iris and fixed IOL [18]

Summary

Introduction

Descemet membrane endothelial keratoplasty (DMEK) is a new method of corneal endothelial keratoplasty introduced by Melles et al [1], which allows rapid recovery of visual acuity and minimizes immunological rejection [1,2,3,4,5]. The eyes that are most suitable for DMEK are thought to be pseudophakic bicameral eyes with normal anterior chamber depth. When DMEK is performed on an eye containing a sutured intraocular lens (IOL), the IOL should be properly centered within the lens capsule, providing an intact irisIOL diaphragm. The indications of DMEK have been widely expanded to many endothelial disorders, the eyes with iris abnormalities or sutured IOL are thought to be unsuitable for DMEK [14,15,16,17,18], because the graft might be lost through the peripheral iris defect or the interspace between the iris and fixed IOL [18]

Objectives

Methods

Conclusion