Clinical Outcomes And Complication Rates Of Pi-Less Descemet Membrane Endothelial Keratoplasty: A Systematic Review And Meta-Analysis.
Published 2026 - 44th Congress of the ESCRS
Reference: PP11.10 | Type: Free paper | DOI: 10.82333/rhn9-7c68
Authors: Dr Nafsika Anastasia Voulgari* 1 , Hamidreza Zare 1 , Andreas Katsimpris 2 , Harinderjeet Sandhu 1
1University Hospital Southampton NHS Foundation Trust,Southampton,United Kingdom, 2Princess Alexandra Eye Pavilion,Edinburgh,United Kingdom
Purpose
This analysis aimed to evaluate safety and clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed without prophylactic peripheral iridectomy/iridotomy (PI-less).
Setting
Systematic review and meta-analysis.
Methods
PubMed, Embase, Scopus and Google Scholar were systematically searched for studies published up to February 2025. We included clinical studies reporting outcomes of DMEK performed without prophylactic PI prior to or during surgery.Main outcome measures were pupillary block, graft detachment, rebubbling, best-corrected visual acuity (logMAR)(BCVA), endothelial cell density (ECD), endothelial cell loss (ECL), graft failure, postoperative intraocular pressure (IOP) spikes. Random-effects meta-analysis of proportions was conducted for complication rates, and pooled means were calculated for visual acuity and endothelial parameters.
Results
Ten clinical studies with a total of 489 eyes were included in the meta-analysis. Pupillary block incidence was 3.47% (95% CI 0.35–8.59; I²=78%, N=10). Graft detachment occurred in 34.2% (25.7–43.2; I²=74%, N=10), and rebubbling in 26.7% (20.0–34.0; I²=64%, N=10). Graft failure rate was 3.4% (1.7–5.5; I²=0%, N=10). IOP spikes not related to pupillary block, occurred in 2.8% (1.1–5.0; I²=0%, N=7). Pooled postoperative BCVA was 0.27 logMAR (0.19–0.34, N=6). Mean ECL was 38.3% (31.3–45.9, N=3), with final ECD 1814 cells/mm² (1624–2004, N=4).
Conclusions
This meta-analysis demonstrates that PI-less DMEK is safe and effective with rates of pupillary block, graft detachment and rebubbling comparable to DMEK with PI, without compromising graft viability and avoiding the risks of PI. Careful postoperative monitoring remains essential. Prospective comparative studies are needed.