VITREOMACULAR TRACTION AFTER PHAKIC, PSEUDOPHAKIC AND TRIPLE DMEK.

Published 2023 - 27th ESCRS Winter Meeting

Reference: O25 | Type: Free Paper Submission | DOI: 10.82333/2azz-4p12

Authors: Sarah Barbara Zwingelberg* ¹ , Stephanie Bresgen ¹ , Claus Cursiefen ¹ , Friederike Schaub ²

¹Department of Ophthalmology,University of Cologne,Cologne,Germany, ²Department of Ophthalmology,University of Rostock,Rostock,Germany;Department of Ophthalmology,University of Cologne,Cologne,Germany

Purpose

The aim of this study was to analyze the incidence of anomalous posterior vitreous detachment (PVD), the progression and development of vitreomacular traction (VMT) and possible risk factors after DMEK.

Setting

All eyes that underwent a first DMEK surgery with a preoperative macular examination by SD-OCT between July 2011 and December 2018 and had a follow-up of at least 1 year were included in the study.

Methods

All eyes were examined by SD-OCT (SPECTRALIS® HRA+OCT, Heidelberg Engineering GmbH, Heidelberg, Germany) preoperatively and at each postoperative visit (1, 3, 6, 12 months and annually thereafter).The occurrence of VMT was defined as an incomplete but partial PVD temporal to the fovea with traction on the fovea with edematous or cystic changes.

Results

1076 patients were screened, of which 57 eyes underwent phakic DMEK (5.3%), 480 underwent pseudophakic DMEK (44.6%), and 539 underwent triple DMEK procedures (50.1%).

The median follow-up time was 18.3 + 12.2 months. Preoperatively, 6.5% (n= 70) had a VMT.

Triple DMEK procedures (n=46; 8.5%) showed a slightly increased preoperative incidence of VMTs compared to pseudophakic (n=13; 2.7%; p = 0.174) and phakic DMEK procedures (n=11; 19.3%; p = 0.125), with a small sample size of phakic patients.

Preoperative VMTs regressed significantly more frequently 12 months after triple DMEK than in the other two types of surgery (p = 0.013).

In contrast, 12 months after surgery, the pseudophakic and phakic DMEK group showed a slightly increased incidence of VMTs compared to preoperatively (pseudophakic: p = 0.091; phakic = 0.49).

The use of gas (sulfur hexafluoride, SF6 20%) as an anterior chamber tamponade in DMEK tended to result in PVD more frequently, whereas a slightly increased incidence of VMT was observed when air was used as a tamponade during the postoperative course.

Conclusion

DMEK in combination with cataract surgery seems to favor PVD and thus resolution of VMT.