Long-Term Outcomes Of The Safety-Net Dmek Technique For Aphakia.

Published 2026 - 44th Congress of the ESCRS

Reference: PP11.11 | Type: Free paper | DOI: 10.82333/x1rh-b650

Authors: Mr Kirupakaran Arun* ¹ , Mr Rohan Hussain ¹ , Mr Christopher Ashton ¹ , Mr Johnson Neo ¹ , Mr Mohammed Aamir Ismailjee ¹ , A/Prof. Bruce Allan ¹ , Mr Alfonso Perez ¹

¹Moorfields Eye Hospital,London,United Kingdom

Purpose

Unicameral eyes, including aphakic and aniridic eyes, have traditionally been considered unsuitable for Descemet membrane endothelial keratoplasty (DMEK) due to the risk of posterior graft dislocation. A safety-net suture modification was developed at Moorfields Eye Hospital to enable DMEK in these complex cases. We report long-term outcomes from the largest consecutive case series to date evaluating safety-net DMEK in aphakic and unicameral eyes.

Setting

Tertiary referral centre, Moorfields Eye Hospital, London, United Kingdom.

Methods

A retrospective consecutive case series was conducted including all safety-net DMEK procedures performed between January 2019 and July 2024. Data collected included demographics, ocular comorbidities, cause of aphakia or aniridia, best-corrected visual acuity (BCVA), tamponade agent, rebubbling rate, graft survival, and complications. Pre- and postoperative BCVA were converted to logMAR for statistical analysis. Paired non-parametric testing was used to compare visual outcomes. Kaplan–Meier survival analysis was performed to estimate graft survival.

Results

Twenty one eyes underwent safety-net DMEK. Post-op follow up range from 1 year to 5 years. Mean patient age was 65.3 years (range 40–91). Most eyes were aphakic secondary to trauma or complex intraocular surgery, with frequent coexisting pathology including glaucoma and previous retinal detachment.

Rebubbling was required in 5/21 eyes (23.8%). Graft failure and/or repeat keratoplasty occurred in 4/21 eyes (19%). Posterior graft dislocation was prevented in all cases. Kaplan–Meier analysis estimated graft survival at 5 years to be 65%.

Statistically significant improvement in BCVA was observed postoperatively despite the high prevalence of pre-existing ocular pathology (p<0.05).

Conclusions

Safety-net DMEK is a feasible and effective option for aphakic and unicameral eyes traditionally considered unsuitable for DMEK. Significant visual improvement can be achieved despite complex comorbidity, with acceptable rebubbling and graft failure rates. The technique reliably prevents posterior graft dislocation and enables selected complex patients to benefit from the anatomical and visual advantages of DMEK, representing a viable alternative to DSAEK in challenging eyes.