DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY IN VITRECTOMISED EYES

To analyze the results of Descemet Membrane Endothelial Keratoplasty (DMEK) in patients with vitrectomised eyes .

Retrospective case series study at a tertiary referral center.

Twenty-three eyes that had undergone vitrectomy prior to DMEK were retrospectively analyzed from 478 DMEK procedures performed between November 2013 and June 2023, with regular follow-up for at least 6 months. Best corrected visual acuity (BCVA), change in central corneal thickness (CCT), decrease in mean endothelial cell count (ECT), rebubbling rate, intraoperative and postoperative complications and DMEK success were recorded.

The mean age of the patients was 67.91±9.18 years. The mean follow-up period of the patients was 9.3±5.47 months. A statistically significant increase was achieved in the final mean BCVA (1.32, logMAR) compared to the mean BCVA in the preoperative period (2.51,logMAR) (P<0.05). The mean CCT decreased from 863 ±61 µm preoperatively to 664 ± 131 µm in the 6 months (P<0.05). The mean donor ECT decreased from 3106 ± 244 cells/mm² preoperatively to 1470 ± 340 cells/mm²  in the 6th month (P<0.05). Five eyes required rebubbling (21%), of which two resulted in graft failure. Overall, 7 eyes demonstrated graft failure (30%). Three eyes (13%) underwent re-DMEK. Three eyes (13%) underwent penetrating keratoplasty (PK), one of which had keratitis. Two eyes (9%) developed glaucoma, and two eyes (9%) developed keratitis.

DMEK surgery in vitrectomised eyes requires careful preoperative planning and despite intraoperative challenges such as inadequate vitreous support and unstable iris lens diaphragm, DMEK surgery can be successfully performed in vitrectomised eyes because it has fewer complications than penetrating keratoplasty and leaves the opportunity for subsequent penetrating keratoplasty, and because acceptable visual acuity levels can be achieved.