Descemet Membrane Endothelial Keratoplasty (DMEK) in Previously Vitrectomized Eyes: Complications and Clinical Outcomes

Abstract Purpose To evaluate the results and complications of Descemet membrane endothelial keratoplasty (DMEK) in previously vitrectomized eyes. Design Retrospective study of 35 eyes that had undergone DMEK, due to Fuchs endothelial corneal dystrophy (FECD), at our department with a follow-up after 6 months postoperatively. We compared the intraoperative procedure, complications, and results of DMEK between 14 previously vitrectomized pseudophakic eyes (group 1) and a control group of 21 pseudophakic non-vitrectomized eyes (group 2). Results The unfolding time (in minutes) was significantly longer in group 1 than in group 2 (10.5 ± 6.4 vs. 3.2 ± 1.5, p < 0.01). A single re-bubbling was needed in 8 patients in group 1 (57.1%) and in 3 patients in group 2 (14.2%) (p < 0.01). Repeated re-bubbling (≥ 1 time) was performed in only 5 patients of group 1 (35.7%). There was significant postoperative improvement in best-corrected visual acuity (BCVA, in LogMAR) in both groups (p = 0.04 in group 1 and p < 0.01 in group 2). The central corneal thickness (CCT, in µm) did not differ significantly between the two groups preoperatively (p = 0.4) or postoperatively (p = 0.1). However, the CCT decreased significantly postoperatively in both groups (p < 0.01 in both groups). The postoperative endothelial cell density (ECD in cell/mm²) was significantly lower in group 1 than in group 2 (p = 0.03). Conclusion DMEK in previously vitrectomized eyes presents a surgical challenge, which requires special, and sometimes unpredictable, intraoperative maneuvers, but good functional and morphological results can be achieved. The use of the endothelial Descemet membrane lamellae (EDML) of older donors might be recommended to facilitate the intraoperative unfolding process.

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Outcomes after Descemet membrane endothelial keratoplasty over a period of 7 years at a tertiary referral center: endothelial cell density, central corneal thickness, and visual acuity

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-021-05152-w ◽

2021 ◽

Author(s):

Tarek Bayyoud ◽

Faik Gelisken ◽

Jens Martin Rohrbach ◽

Gunnar Blumenstock ◽

Karl Ulrich Bartz-Schmidt ◽

...

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Cell Density ◽

Central Corneal Thickness ◽

Corneal Thickness ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Group 2 ◽

Group 1

Abstract Purpose To better assess clinical trajectories of patients with or without ocular comorbidity after Descemet membrane endothelial keratoplasty. Background: To report on the outcomes of eyes with differing starting conditions following surgery. Design: Retrospective study at a University Eye Hospital. Participants: 361 eyes separated into group 1 (n=229; eyes with endothelial disease only) and group 2 (n=132; eyes with additional ocular comorbid conditions, such as herpetic eye disease 18/132 (13.6%), glaucoma 16/132 (12.1%), dry age-related macular degeneration 14/132 (10.6%), epiretinal membranes 10/132 (7.6%), and wet age-related macular degeneration 9/132 (6.8%)). Methods Consecutive eyes that underwent Descemet membrane endothelial keratoplasty over a follow-up period of up to 7 years at a tertiary referral center were reviewed. Main outcome measures were best-corrected visual acuity, postoperative complications, graft survival, central corneal thickness, and endothelial cell density. Results Postoperative best-corrected visual acuity at year 1 improved in both groups significantly (Wilcoxon signed rank test: group 1, p =.002; .63 to .23 logMAR; group 2, p <.001; 1.15 to .87 logMAR) with a group difference in favor of group 1 (p =.009, Mann-Whitney-Wilcoxon). A decrease of the endothelial cell density and central corneal thickness was noted at postoperative year 1 for both groups (paired t-tests (group 1, p <.001; group 2, p =.045) and paired t-tests (group 1, p <.001; group 2, p =.003). Complications were less common, and graft longevity was superior in group 1. Conclusion Eyes with different starting conditions might experience a visual improvement and benefit from surgery. Descemet membrane endothelial keratoplasty is a valid treatment for endothelial disorders in manifold of eyes. Further long-term studies are required.

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Chord Mu (µ) and Chord Alpha (α) Length Changes in Fuchs Endothelial Corneal Dystrophy before and after Descemet Membrane Endothelial Keratoplasty (DMEK) Surgery

Journal of Clinical Medicine ◽

10.3390/jcm10214844 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4844

Author(s):

Carlos Rocha-de-Lossada ◽

José-María Sánchez-González ◽

Davide Borroni ◽

Víctor Llorens-Bellés ◽

Rahul Rachwani-Anil ◽

...

Keyword(s):

Corneal Dystrophy ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Post Surgery ◽

Before And After ◽

Length Changes ◽

Corneal Apex ◽

Center Distance

This paper will evaluate chord mu and alpha length in patients with Fuchs endothelial corneal dystrophy (FECD) and its changes following Descemet membrane endothelial keratoplasty (DMEK). Patients with FECD that underwent DMEK surgery were included in this retrospective study. Scheimpflug Tomography was carried out in order to calculate chord mu and chord alpha lengths prior to surgery and at 3 and 12 months postoperative. This study included 27 eyes from 27 patients. Significant changes in chord mu were observed within the first three months (from 0.47 ± 0.32 to 0.29 ± 0.21 mm, p < 0.01) and remained stable 12 months postoperative (0.30 ± 0.21 mm, p > 0.05). However, chord alpha remained stable throughout the 12 months post surgery (from 0.53 ± 0.19 to 0.49 ± 0.14 mm, p > 0.05). In addition to the pupillary center distance from the corneal apex (from 0.35 ± 0.25 to 0.34 ± 0.20 mm, p > 0.05) also remain stable. In FECD patients undergoing DMEK surgery, chord mu length decreased, and chord alpha length remained stable after 12 months of follow-up.

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Impact of Introducing 2 Simple Technique Modifications on the Descemet Membrane Endothelial Keratoplasty Learning Curve

European Journal of Ophthalmology ◽

10.5301/ejo.5000808 ◽

2016 ◽

Vol 27 (1) ◽

pp. 16-20 ◽

Cited By ~ 10

Author(s):

Francisco Arnalich-Montiel ◽

Ane Pérez-Sarriegui ◽

Alfonso Casado

Keyword(s):

Learning Curve ◽

Graft Failure ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Primary Graft Failure ◽

Air Tamponade ◽

Group 2 ◽

The Impact ◽

Group 1

Purpose To analyze the impact of performing premarking of the Descemet roll and using SF6 20% on a surgeon's Descemet membrane endothelial keratoplasty (DMEK) learning process. Methods A total of 30 consecutive eyes with endothelial dysfunction undergoing DMEK during the learning curve of a surgeon were retrospectively analyzed. Prior to the study, the surgeon had already performed 10 DMEKs. The first 15 consecutive patients were included in group 1 (no premarking and air tamponade) and the other 15 consecutive patients were included in group 2 (premarking and SF6 tamponade). Main outcome parameters were best-corrected visual acuity (BCVA), endothelial cell density (ECD) loss at 6 months, and intraoperative and postoperative complications. Results Among the 2 groups, BCVA and ECD loss at 6 months were similar. However, there was a statistically significant reduction in primary graft failure (40% vs 0%) and need of rebubbling due to complete or partial graft detachment (40% vs 6%) when comparing group 1 versus group 2. In group 1, half of the patients needing rebubbling had primary graft failure. Conclusions Based on our personal experience, premarking the graft to assess orientation and using a SF6 gas tamponade dramatically reduces the risk of primary graft failure and the need for rebubbling even during the first stages of the learning curve. These findings should encourage surgeons to safely change from Descemet stripping automated endothelial keratoplasty to DMEK.

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Descemet membrane endothelial keratoplasty: analysis of clinical outcomes of patients with 8–10 years follow-up

International Ophthalmology ◽

10.1007/s10792-021-02176-3 ◽

2022 ◽

Author(s):

Julia M. Weller ◽

Friedrich E. Kruse ◽

Theofilos Tourtas

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Clinical Outcomes ◽

Cell Density ◽

Corneal Thickness ◽

Endothelial Cell Density ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane

Abstract Purpose This study aimed to evaluate the clinical outcomes up to 10 years after Descemet membrane endothelial keratoplasty (DMEK). Methods In this retrospective, consecutive, single-center case series the medical files of eyes which have received DMEK between 2009 and 2012 for the treatment of endothelial dysfunction was evaluated regarding follow-up time and clinical outcomes. Annual examinations of best-corrected visual acuity (BCVA), endothelial cell density (ECD), central corneal thickness (CCT) of 66 eyes which fulfilled the criterion of a minimum of 8 years follow-up were analyzed. Results BCVA improved from 0.55 ± 0.37 logMAR (n = 54) to 0.15 ± 0.11 (n = 47) in eyes without ocular comorbidities one year after DMEK (p < 0.001), and remained stable up to 10 years after DMEK. Mean ECD decreased to 744 ± 207 cells/mm2 (n = 39) after 9 years, and to 729 ± 167 cells/mm2 (n = 21) after 10 years, respectively. CCT decreased from 650 ± 67 μm before DMEK to 525 ± 40 μm (n = 56) after 1 year, increasing slowly to 563 ± 40 µm (n = 39) after 9 years, and to 570 ± 42 µm (n = 21) after 10 years, respectively. Graft failure occurred in 4 of 66 eyes after year 8. These 4 eyes required repeat DMEK after 101–127 months. Conclusion This study shows the long-term outcomes in a small subset of DMEK grafts. Visual acuity remained stable in spite of slowly increasing corneal thickness and diminishing endothelial cell density during the 10-year period after DMEK.

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Graft survival of Descemet membrane endothelial keratoplasty (DMEK) in corneal endothelial decompensation after glaucoma surgery

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-021-05506-4 ◽

2021 ◽

Author(s):

Silvia Schrittenlocher ◽

C. Grass ◽

T. Dietlein ◽

A. Lappas ◽

M. Matthaei ◽

...

Keyword(s):

Survival Time ◽

Graft Survival ◽

Graft Failure ◽

Glaucoma Drainage Device ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Department Of Ophthalmology ◽

Group 2 ◽

Group 1

Abstract Purpose This study aims to assess the results, rebubbling rate, and graft survival after Descemet membrane endothelial keratoplasty (DMEK) with regard to the number and type of previous glaucoma surgeries. Methods This is a clinical retrospective review of 1845 consecutive DMEK surgeries between 07/2011 and 08/2017 at the Department of Ophthalmology, University of Cologne. Sixty-six eyes were included: group 1 (eyes with previous glaucoma drainage devices (GDD); n = 27) and group 2 (eyes with previous trabeculectomy (TE); n = 39). Endothelial cell loss (ECL), central corneal thickness, graft failure, rebubbling rate, and best spectacle-corrected visual acuity (BSCVA) up to 3 years after DMEK were compared between subgroups of patients with different numbers of and the two most common types of glaucoma surgeries either GDD or TE or both. Results Re-DMEK rate due to secondary graft failure was 55.6% (15/27) in group 1 and 35.9% in group 2. The mean graft survival time in group 1 was 25 ± 11 months and 31.3 ± 8.6 months in group 2 (p = 0.009). ECL in surviving grafts in group 1 was 35% (n = 13) at 6 months, 36% at 12 months (n = 8), and 27% (n = 4) at 2 years postoperatively. In group 2, ECL in surviving grafts was 41% (n = 10) at 6 months, 36% (n = 9) at 12 months, and 38% (n = 8) at 2 years postoperatively. Rebubbling rate in group 1 was 18.5% (5/27) and 35.9% (14/39) in group 2 (p = 0.079). Conclusion Eyes with previous GDD had no higher risk for an increased rebubbling rate but a higher risk for a re-DMEK due to secondary graft failure with a mean transplant survival time of about 2 years. Compared to eyes with preexisting glaucoma drainage device, eyes after trabeculectomy had less secondary graft failures and a longer mean graft survival rate.

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

Journal of Ophthalmology ◽

10.1155/2018/3127126 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Norihiro Yamada ◽

Takahiko Hayashi ◽

Kentaro Yuda ◽

Toshiki Shimizu ◽

Itaru Oyakawa ◽

...

Keyword(s):

Intraocular Lens ◽

Corneal Thickness ◽

Control Group ◽

Posterior Chamber ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Iol Implantation ◽

Descemet Membrane ◽

Posterior Chamber Intraocular Lens ◽

Pars Plana

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.

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Refractive accuracy in eyes undergoing combined cataract extraction and Descemet membrane endothelial keratoplasty

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317247 ◽

2021 ◽

pp. bjophthalmol-2020-317247

Author(s):

Jack A Campbell ◽

John G Ladas ◽

Kendrick Wang ◽

Fasika Woreta ◽

Divya Srikumaran

Keyword(s):

Corneal Thickness ◽

Cataract Extraction ◽

Absolute Error ◽

Corneal Dystrophy ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Optical Biometry ◽

Corneal Power ◽

Descemet Membrane ◽

The Difference

PurposeTo evaluate the refractive accuracy of current intraocular lens (IOL) formulas and propose a modification in calculation of corneal power in eyes undergoing combined cataract extraction and Descemet membrane endothelial keratoplasty (DMEK).DesignRetrospective cohort study.MethodsPatients with Fuchs endothelial corneal dystrophy undergoing uncomplicated combined cataract surgery and DMEK at a single institution were included. The Hoffer Q, SRK/T, Holladay I, Barrett Universal II and Haigis formulas were compared. A modified corneal power was calculated using a thick lens equation based on anterior and posterior corneal radii and corneal thickness from Pentacam imaging. Error calculations were adjusted based on the difference in optical biometry and the modified corneal power. Mean absolute error (MAE) for each formula was compared between the corneal power modification and optical biometry corneal power.ResultsIn 86 eyes, the mean error ranged from 0.90 D for the Barrett Universal II formula to −0.10 D for the Haigis formula, with 4 of 5 formulas resulting in a mean hyperopic error. The corneal power modification resulted in a significantly lower MAE for the Hoffer Q (0.82 D), Holladay I (0.85 D), SRK/T (0.85 D) and Barrett Universal II (0.90 D) formulas compared with optical biometry corneal power for the Hoffer Q (1.02 D; p<0.005), Holladay I (0.97 D; p<0.005), SRK/T (0.93 D; p<0.01) and Barrett Universal II (1.16 D; p<0.005) formulas.ConclusionsAll formulas except the Haigis formula resulted in a hyperopic error. The corneal power modification significantly reduced error in four out of five IOL formulas.

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Refractive outcome and tomographic changes after Descemet membrane endothelial keratoplasty in pseudophakic eyes with Fuchs’ endothelial dystrophy

International Ophthalmology ◽

10.1007/s10792-021-01850-w ◽

2021 ◽

Author(s):

Bishr Agha ◽

Nura Ahmad ◽

Daniel G. Dawson ◽

Thomas Kohnen ◽

Ingo Schmack

Keyword(s):

Central Corneal Thickness ◽

Corneal Thickness ◽

Corneal Astigmatism ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Corneal Densitometry ◽

Scheimpflug Imaging ◽

Fuchs Endothelial Dystrophy ◽

Posterior Corneal Astigmatism

Abstract Purpose To analyze refractive and topographic changes secondary to Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic eyes with Fuchs’ endothelial dystrophy (FED). Methods Eighty-seven pseudophakic eyes of 74 patients who underwent subsequent DMEK surgery for corneal endothelial decompensation and associated visual impairment were included. Median post-operative follow-up time was 12 months (range: 3–26 months). Main outcome measures were pre- and post-operative manifest refraction, anterior and posterior corneal astigmatism, simulated keratometry (CASimK) and Q value obtained by Scheimpflug imaging. Secondary outcome measures included corrected distance visual acuity (CDVA), central corneal densitometry, central corneal thickness, corneal volume (CV), anterior chamber volume (ACV) and anterior chamber depth (ACD). Results After DMEK surgery, mean pre-operative spherical equivalent (± SD) changed from + 0.04 ± 1.73 D to + 0.37 ± 1.30 D post-operatively (p = 0.06). CDVA, proportion of emmetropic eyes, ACV and ACD increased significantly during follow-up. There was also a significant decrease in posterior corneal astigmatism, central corneal densitometry, central corneal thickness and corneal volume over time (p = 0.001). Only anterior corneal astigmatism and simulated keratometry (CASimK) remained fairly stable after DMEK. Conclusion Despite tendencies toward a hyperopic shift, changes in SE were not significant and refraction remained overall stable in pseudophakic patients undergoing DMEK for FED. Analysis of corneal parameters by Scheimpflug imaging mainly revealed changes in posterior corneal astigmatism pointing out the relevance of posterior corneal profile changes during edema resolution after DMEK.

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THE ROLE OF MYOCARDIAL REVASCULARIZATION IN THE SURVIVAL OF PATIENTS WITH ALTERED CORONARY BLOOD FLOW DETECTED BY TRANSTHORACIC ULTRASOUND

Siberian Medical Journal ◽

10.29001/2073-8552-2018-34-1-54-60 ◽

2019 ◽

Vol 34 (1) ◽

pp. 54-60

Author(s):

M. S. Kamenskikh ◽

A. V. Zagatina ◽

N. T. Zhuravskaya ◽

Yu. N. Fedotov ◽

D. V. Shmatov

Keyword(s):

Blood Flow ◽

Coronary Blood Flow ◽

Myocardial Revascularization ◽

Control Group ◽

P Value ◽

Coronary Events ◽

Group 2 ◽

Group 1 ◽

Flow Velocities

Aim of the study was to identify the effects of myocardial revascularization on the prognosis in patients with altered coronary blood flow detected by transthoracic ultrasound.Material and Methods. Four hundred and twelve (412) patients were included in the study. The inclusion criterion was coronary velocity more than 70 cm/s during echocardiography. The study population was divided into three groups: Group 1 comprised patients with high velocities in the coronary arteries detected by ultrasound, in whom myocardial revascularization was performed; Group 2 comprised patients with high velocities in the coronary arteries, in whom myocardial revascularization was not performed and; the Control Group comprised patients with normal coronary blood flow according to ultrasound. The follow-up period was 10–11 months.Results. Seventeen (17) deaths (4.7%) occurred during follow-up. Death rates were 1.6 vs. 8.1 vs. 0% in Group 1, Group 2 and the Control Group, respectively, with a p-value for the difference between Group 1 and Group 2 (p1) of <0.009; and a p-value for the differences compared with the Control group (р2) of <0.03. Death, myocardial infarction, pulmonary edema, and acute coronary syndrome were observed in 27 patients (7.7% of the study group with accelerated blood flow). The rates of these outcomes were 4.9 vs. 11.0 vs. 0% in Group 1, Group 2, and the Control Group, respectively (p1<0.05; p2<0.006). Discussion. The study showed high rates of mortality or acute coronary events in the group of patients with pathologically high coronary flow velocities. The positive effects of revascularization on survival in this group were verified.Conclusions: 1. Left artery coronary flow velocities over 70 cm/s indicate a high probability of death or acute coronary events within 10.5 months.2. Myocardial revascularization has a significant positive effect on the survival rate and incidence of acute coronary events in patients with coronary artery flow velocities greater than 70 cm/s.3. Patients with high coronary blood flow velocities should be referred to coronary angiography or other diagnostic tests without waiting for clinical manifestations and specific symptoms for coronary artery disease.

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