ARE SAME DAY AND DAY ONE POSTOPERATIVE REVIEWS CLINICALLY NECESSARY AFTER DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY (DMEK) PERFORMED WITH AN INFERIOR PERIPHERAL IRIDOTOMY (PI)?

To determine the incidence of day 1 postoperative complications after DMEK performed with intraoperative inferior PI, and whether their early detection influences post-operative intervention.

Currently it is standard practice to review post-DMEK patients on the same day as surgery and/or the following day, to detect early complications such as high intraocular pressure due to pupil block, inadequate bubble size or graft detachment.

Patients that underwent either DMEK alone or combined with phacoemulsification and posterior chamber intraocular lens insertion (triple DMEK) between August 2019 and August 2021 were identified. Patients not receiving PI were excluded. Laterality, grade of surgeon and any action taken at day one and week one review were noted.

72 DMEKs with inferior PI were performed, of which 43 (59.7%) were triple DMEK. 20 cases (27.7%) were performed by a consultant ophthalmologist, with the remainder performed by a fellow. No pupil block or other major adverse events were found at day one review. At one week, 14 (19.4%) required re-bubbling, 2 (2.8%) required repositioning, 1 (1.4%) required re-graft and 1 (1.4%) underwent YAG laser to vitreous strands prolapsed through the PI.

This series suggests that inferior PI performed alongside DMEK alone or triple DMEK effectively minimizes the risk of pupil block. Since no early complications occurred in this cohort requiring immediate intervention, it may be safe to defer review of these patients to a later time point. This may improve graft success rates in an outpatient setting by maximising uninterrupted posturing time and may be more practical in public-funded healthcare settings.