IS ROUTINE PERIPHERAL IRIDOTOMY REALLY NECESSARY IN DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY?
Published 2023
- 27th ESCRS Winter Meeting
Reference: P117
| Type: Free Paper Submission
| DOI:
10.82333/eay5-0t55
Authors:
Ritika Mukhija* 1
, Gabriella Quiney 2
, Mayank Nanavaty 1
1Ophthalmology,Sussex Eye Hospital,Brighton,United Kingdom, 2Brighton & Sussex Medical School,Brighton,United Kingdom
Purpose
Peripheral iridotomy (PI) is often performed before or during Descemet’s membrane endothelial keratoplasty (DMEK) to prevent pupillary block occurring as a result of tamponade with air or gas, but despite this pupillary block may occur. The aim of this study is to report and analyse the outcomes and complications of DMEK performed without PI.
Setting
institutional, tertiary care eye hospital
Methods
Methodology: Retrospective case series.
Study Population and Criteria: All patients who underwent DMEK or DMEK combined with phacoemulsification (DMEK triple) for Fuch's Endothelial Dystrophy, using a standardized protocol between Aug 2016 to July 2021, were included. Previous glaucoma surgery, laser PI, aphakia or complicated pseudophakia were excluded.
Main Outcome Measures: Primary outcome: incidence of the pupillary block (PB). Secondary outcomes: graft detachment (GD), rebubbling rates, best corrected LogMAR distance visual acuity (BCDVA) and endothelial cell loss (ECL) at six months.
Results
104 eyes of 72 patients were included. Of these, 77 eyes were phakic and underwent DMEK triple and 27 eyes were pseudophakic and underwent DMEK. Air was used as tamponade for 27 eyes and SF6 gas for 77 eyes. Four eyes (3.8%) developed PB. In two of these cases of PB, the standard protocol was not followed; in the other two there was inadequate release of gas and aqueous on day 1. Significant GD occurred in 7 eyes (6.6%), and rebubbling in theatre was needed in 4 eyes (3.8%). PB, GD and rebubbling rates did not vary with the surgeon, surgery, or tamponade (air or SF6 gas). BCDVA and ECL at 6 months were 0.20±0.28 and 40.46±20.36% respectively.
Conclusion
Compared to previously reported outcomes of DMEK with PI, our results of PI less DMEK have a similar incidence of pupillary block, graft detachment, and rebubbling, with comparable visual acuity and endothelial cell loss. Comparable complications rates between type of surgery and surgeon emphasizes importance of following standardised protocol.