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DMEK in an aphakic vitrectomized eye with large iris defect: problems and solutions

Poster Details

First Author: E.Ozdemir TURKEY

Co Author(s):    M. Ozmen                    

Abstract Details

Purpose:

To report the feasibility and outcome of Descemet�â�€�™s membrane endothelial keratoplasty (DMEK) in an aphakic, previously vitrectomized eye with large iris defect and scleromalacia.

Setting:

Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey

Methods:

A 58-year old male was referred to our clinic with endothelial decompensation after having combined vitrectomy and scleral-fixated IOL implantation following trauma. Examination revealed a visual acuity of counting fingers at 2 meters, bullous keratopathy with 360�Â�° of superficial and stromal vascularization, 3 clock hours of iris defect and scleromalacia. Central corneal thickness (CCT) was 884�Î�¼ and DMEK was planned. Following descemetorhexis, scleral-fixated IOL was observed to be subluxated and removed. Surgery was continued in the now aphakic, vitrectomized eye without the support of iris in superior quadrants. Pars plana infusion was used as needed to maintain anterior chamber stability.

Results:

Infusion fluid successfully prevented globe collapse during the surgery and a pre-prepared DMEK graft was introduced over the relatively intact iris tissue. Positive pressure of the infusion eased the indirect manipulations to unfold the graft. Gradually increased air injection under the graft provided further unfolding of the DMEK roll at the stromal surface and tamponaded it. SF6 gas was left at the end. The next day, gas bubble migrated to the posterior segment. However, the graft remained properly positioned and no re-bubbling was required at the follow-up. Three months postoperatively, corrected visual acuity improved to 20/200 and CCT was 748�Î�¼.

Conclusions:

DMEK appears to be a feasible treatment method for endothelial decompensation in complicated cases such as eyes with aphakia, defective iris and vitrectomized globes. In these cases that lack support by iris-lens diaphragm and vitreous, pars plana infusion is helpful both to stabilize the globe and effectively tamponade the graft against the recipient stroma. In the cases with large iris defects, unfolding of the graft may be managed at the stromal surface with additional support of air.

Financial Disclosure:

NONE

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