Large diameter descemet membrane endothelial keratoplasty in buphthalmic eyes

To report the outcomes of Descemet membrane endothelial keratoplasty (DMEK) using a large diameter graft in the management of endothelial decompensation in buphthalmic eyes.

Four eyes of 4 adults (1 man, 3 women) with bullous keratopathy and buphthalmos secondary to congenital glaucoma were treated with DMEK using posterior lamellar grafts with diameters ranging from 10 to 12 mm. The mean age was 31 (±9) years (range, 20-38 years). Mean follow-up time was 13.5 (±7.5) months (range, 6-24 months). Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), pachymetry, endothelial cell density, and complications after surgery.

In all eyes, there was improved corneal clarity with decrease in pachymetry. The final postoperative BCVA improved in most eyes. There was no significant change in IOP, with 3 eyes needing additional antiglaucoma medication. Endothelial cell loss ranged from 37% to 42%. Postoperative complications were early partial graft detachment in 2 eyes, one resolving spontaneously without intervention and the other requiring a rebubbling, and cataract formation requiring phacoemulsification in 1 eye.

DMEK using a large or even full diameter Descemet membrane graft may be an effective treatment for bullous keratopathy in buphthalmic eyes. Partial graft detachment after surgery may be the main complication. Postoperative IOP control is mandatory, and BCVA may vary with ocular comorbidity unrelated to the transplanted cornea.