Descemet Membrane Endothelial Keratoplasty Without Peripheral Iridotomy: Outcomes And Safety Profile

Pupil block with raised intraocular pressure (IOP) is a serious complication of Descemet’s membrane endothelial keratoplasty (DMEK). To reduce the risk of pupil block, many surgeons perform a peripheral iridotomy (PI) before or during the procedure, which itself carries a risk of complications. This study demonstrates the outcomes of a method which does not require a PI.

Single centre, tertiary eye hospital

Retrospective study of DMEK performed under two surgeons. A PI is not made either before or during the surgery as part of their standard technique. Gas is released post-procedure as required in order to avoid iatrogenic pupil block.

Fifty-seven consecutive cases of DMEK between January 2018 to August 2021 were included. Fourteen of these cases were combined with phacoemulsification. There were no cases of raised IOP secondary to pupil block in the post-operative period. Three cases of raised IOP were attributable to a history of glaucoma and steroid response. At one year, there was a mean improvement in best-corrected visual acuity (BCVA) of LogMAR 0.44, from a baseline of LogMAR 0.66. The rebubbling rate was 30%, including partial and complete detachments. There was one case of primary graft failure.

DMEK without a PI is a safe and effective alternative technique when combined with gas bubble management in the immediate post-operative period. Avoiding the need for a PI would eliminate PI-related complications, while saving on cost and resources.