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

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.

Download Full-text

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

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-1517-4518 ◽

2021 ◽

Author(s):

Wissam Aljundi ◽

Alaadin Abdin ◽

Shady Suffo ◽

Berthold Seitz ◽

Loay Daas

Keyword(s):

Corneal Thickness ◽

Corneal Dystrophy ◽

Control Group ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Group 2 ◽

Postoperative Improvement ◽

Group 1

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.

Download Full-text

Long-Term Outcome of Combined Pars Plana Vitrectomy and Scleral Fixated Sutured Posterior Chamber Intraocular Lens Implantation

American Journal of Ophthalmology ◽

10.1016/j.ajo.2005.09.012 ◽

2006 ◽

Vol 141 (2) ◽

pp. 308-312.e1 ◽

Cited By ~ 136

Author(s):

Brendan J. Vote ◽

Paris Tranos ◽

Catey Bunce ◽

David G. Charteris ◽

Lyndon Da Cruz

Keyword(s):

Intraocular Lens ◽

Pars Plana Vitrectomy ◽

Posterior Chamber ◽

Intraocular Lens Implantation ◽

Term Outcome ◽

Long Term Outcome ◽

Posterior Chamber Intraocular Lens ◽

Lens Implantation ◽

Pars Plana

Download Full-text

Phacoemulsification and Posterior Chamber Intraocular Lens (IOL) Implantation

Encyclopedia of Ophthalmology ◽

10.1007/978-3-540-69000-9_101346 ◽

2018 ◽

pp. 1358-1358

Keyword(s):

Intraocular Lens ◽

Posterior Chamber ◽

Iol Implantation ◽

Posterior Chamber Intraocular Lens

Download Full-text

Corneal oedema with in situ implantable collamer lens: a challenging scenario for descemet membrane endothelial keratoplasty

BMJ Case Reports ◽

10.1136/bcr-2020-240709 ◽

2021 ◽

Vol 14 (5) ◽

pp. e240709

Author(s):

Vineet Pramod Joshi ◽

Pravin Krishna Vaddavalli

Keyword(s):

Posterior Chamber ◽

Endothelial Keratoplasty ◽

Cataract Formation ◽

Descemet Membrane Endothelial Keratoplasty ◽

Phakic Intraocular Lens ◽

Implantable Collamer Lens ◽

Air Bubble ◽

Descemet Membrane ◽

Corneal Decompensation

A 27-year-old woman had foggy vision and photophobia since 10 months after implantation of implantable collamer lens (ICL STAAR Surgical AG, Nidau, Switzerland) with evidence of corneal decompensation and no cataract formation. Descemet membrane endothelial keratoplasty in phakic eyes is challenging, considering presence of posterior chamber phakic intraocular lens (IOL), decreasing the space available in anterior chamber to manoeuvre the graft. Need of inferior peripheral iridotomy in presence of central hole technology in ICL depends on the dynamics of full chamber air bubble. At 8 months, vision had improved to 20/20 and normal IOP with well-attached graft, stable phakic IOL and clear lens.

Download Full-text