PI-LESS DMEK: OUTCOMES FROM 151 EYES AT A UK TERTIARY CENTRE
Published 2026 - 30th ESCRS Winter Meeting
Reference: FP05.02 | Type: Free Paper | DOI: 10.82333/paq6-e237
Authors: Rhea Suribhatla* 1 , Matilde Buzzi 2 , Adeline Kho 1 , Ibrar Ahmed 1 , Saumya Yadav 1 , Derek Tole 1 , Kieran Darcy 1 , Omar Elhaddad 1 , Sarah Schimansky 1
1Bristol Eye Hospital,University Hospitals Bristol and Weston NHS Foundation Trust,Bristol,United Kingdom, 2Eye Clinic,University of Florence,Florence,Italy
Purpose
Descemet’s membrane endothelial keratoplasty (DMEK) is the standard transplant surgery for corneal endothelium disorders. Postoperative air or SF6 transplant tamponades can raise in-traocular pressure (IOP) via pupillary block. Preoperative peripheral iridotomies (PIs) reduce this risk. However, PIs carry risks including inflammation, bleeding and photophobia. Data on DMEK without PIs is limited. We report outcomes from a large cohort of 151 eyes that underwent PI-less DMEK.
Setting
Bristol Eye Hospital, United Kingdom
Methods
We retrospectively reviewed all DMEKs and phaco-DMEKs without PI between September 2021 and August 2023 at Bristol Eye Hospital. Clinical and demographic data was collected from electronic medical records. Outcomes included IOP, IOP-lowering treatment, rebubble rates, and best corrected visual acuity (BCVA). Data were analysed using the unpaired, two-tailed t-test or Chi-squared/Fisher’s tests for continuous and categorical data respectively; p<0.05 was significant.
Results
151 eyes from 147 patients (53.7% female; mean age 73.4 ± 12.1 years) underwent PI-less DMEKs. phaco-DMEK was performed in 56.3% of eyes. The most common indication was Fuchs’ endothelial dystrophy (61.6%). Surgeries were carried out almost equally by consultants (53.0%) and corneal fellows (47.0%).
45.0% of eyes underwent an IOP-lowering procedure at 2 hours postoperatively, most commonly air release. Mean IOP normalised over the first postoperative week, with no cases of pupillary block, prolonged or delayed IOP elevations. After 12 months, 76.9% of eyes had improved VA compared to preoperatively, with a mean improvement of logMAR 0.40 ± 0.33.
Postoperative rebubble rate was 33.8% (n=51), with 23.8% undergoing one rebubble (n=36). DMEKs performed by fellows had a slightly higher rebubble rate compared to those carried out by consultants, which was not significant (38.0% and 30.0%, respectively, p=0.30). The rebubble rate was slightly higher in the DMEK only group (25.8%) than in the phaco-DMEK group (40.0%), although also not significant (p=0.07).
Comparing eyes which did and did not undergo rebubbling, there was no significant difference in frequency of air release performed at 2 hours (39.2% vs 38.0% respectively, p=0.89), postoperative IOPs (p=0.54, 0.27 and 0.45 at 2 hours, 1 day and 1 week, respectively) or mean VA (p=0.44, 0.35 and 0.27 at. 3, 6 and 12 months, respectively). The rebubble rate was slightly higher in the DMEK only group (25.8%) than in the phaco-DMEK group (40.0%), but also not significant (p=0.07).
Conclusion
We report that PI-less DMEK and phaco-DMEK without a routine postoperative air release is a safe technique in our large cohort study of 151 eyes, when performed by both junior and senior surgeons. This surgical technique is cost-efficient, saving on costs of preoperative laser PI or intra- operative surgical PI. Looking ahead, larger case-control studies are required to compare DMEK and phaco-DMEK outcomes with and without prophylactic PI.