Results Of Descemet Membrane Endothelial Keratoplasty In Vitrectomized Eyes

To evaluate demograghic features, surgical challenges and visual outcomes of Descemet membrane endothelial keratoplasty (DMEK) in patients with a history of pars plana vitrectomy.

Ankara City Hospital

In this retrospective study, 19 eyes of 18 DMEK patients with a known history of prior vitrectomy were evaluated. In addition to demographic features and ocular comorbidities, best corrected visual acuity(BCVA) was analyzed after a 6- month follow-up. Surgical time for unfolding and positioning the graft, type of tamponade, rebubbling rate and presence of graft failure were also investigated. 

The main indication for DMEK was aphakic or pseudophakic bullous keratopathy.  BCVA increased for all patients postoperatively (p<0,001).  The mean surgical time for unfolding and positioning the graft was 78,3±62,1 seconds. As a tamponade, air (9 eyes) and varying concentrations of SF6 (5% to 10%) were used(10 eyes). 4 eyes (22,2 %) needed rebubbling. In one case, graft failure was detected due to a silicone bubble in the anterior chamber. Furthermore, one eye had graft rejection due to recent COVID immunization.   

Although DMEK seems to be a favorable option for endothelial dysfunction, complexity of this surgery is increased in vitrectomized eyes. Deep, fluctuating anterior chamber, absence of the mechanical support of the vitreus and an unstable iris-lens diaphragm can impair graft unfolding and positioning. Although DMEK can be more challenging and time consuming in vitrectomized eyes, this surgery can successfully lead to decreased ocular pain, increased level of visual acuity and improved quality of life in these patients.