Descemet membrane endothelial keratoplasty in vitrectomized eyes: clinical results

The aim of this study was to evaluate clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in vitrectomized eyes.

Medical records were reviewed for demographics, baseline and follow-up best spectacle-corrected visual acuities (BCVAs), endothelial cell densities, and indication for DMEK. Operative notes were analyzed to identify any specific intraoperative event.

A total of 281 DMEK cases were reviewed. Twenty cases were considered eligible for the study. Seven eyes had a history of anterior vitrectomy, and 13 eyes had a history of complete removal of the vitreous body. Ages ranged from 37 to 78 years (mean, 62.9 years) and mean follow-up after DMEK was 11.2 months (range, 3-29 months). The preoperative mean BCVA was 1.4 ± 0.5 logarithm of minimum angle of resolution (logMAR) and increased to 1.0 ± 0.5 logMAR after 4 weeks (P = 0.0290). After 6-month and 12-month follow-up, BCVA was 0.8 ± 0.6 logMAR (P = 0.0055) and 0.6 ± 0.3 logMAR (P = 0.0001), respectively. All cases had ocular comorbidities affecting the BCVA. In 13 cases, significant intraoperative complications were experienced. In the immediate postoperative period, iatrogenic primary graft failure was reported in 2 eyes (2/20). In 4 eyes, late graft failure was observed. Two eyes had exacerbation of preexisting glaucoma. Mean preoperative endothelial cell density was 2301 ± 159 cells per square millimeter; postoperative follow-up visits at 6 and 12 months showed a decrease to 1398 ± 161 cells per square millimeter and 1241 ± 155 cells per square millimeter, respectively.

DMEK seems to be successful in restoring visual acuity even in vitrectomized eyes. Nevertheless, the overall complication rate was higher than that in standard DMEK.