Descemet Membrane Endothelial Keratoplasty (Dmek) In Eyes With An Anterior Chamber Intraocular Lens (Ac-Iol): A Single-Centre Experience

To describe the surgical techniques and outcomes of descemet membrane endothelial keratoplasty (DMEK) in eyes with an anterior chamber intraocular lens (AC-IOL)

Tertiary referral centre at Moorfields Eye Hospital NHS Foundation Trust, London

A retrospective review of 11 consecutive DMEK cases in eyes with AC-IOL from January 2019 to September 2022 was carried out. Eyes with prior keratoplasty or documented amblyopia were excluded. Inclusion criteria included a minimum follow-up of 6 months. Pre-operative surgical considerations, intra-operative surgical techniques and modifications, post-operative outcomes including graft attachment, graft rejection and the need for re-bubbling were documented.

Pre-operatively all eyes with AC-IOL selected for DMEK surgery achieved stable visual acuity for ≥4 years prior to developing bullous keratopathy. 2 eyes (18.2%) underwent combined AC-IOL exchange and DMEK surgery due to under-sizing of previous AC-IOL. Suturing of AC-IOL haptics to the iris with 10/0 prolene was performed in 2 eyes (18.2%) to improve implant stability and to ensure adequate anterior chamber depth (>2.0mm) for DMEK surgery. Graft unfolding over AC-IOL and gas tamponade were successful in all cases. 4 eyes (36.4%) required re-bubbling. All eyes achieved improvement in corneal thickness and visual acuity (≥2 Snellen lines) post-operatively with no documented graft rejection within a follow-up period between 6 to 24 months.

DMEK can be safely performed in eyes with AC-IOL with the surgical approach described in our case series. Adequate sizing and stability of AC-IOL are crucial for the success of the surgery. Successful DMEK surgery in these cases would provide a lower risk of graft rejection compared to other forms of keratoplasties and fewer ocular morbidities compared to a 2-stage IOL exchange/keratoplasty.