[DMEK in complicated cases of bullous keratopathy after multiple intraocular surgeries]

During the last decade Descemet membrane endothelial keratoplasty (DMEK) has been established as a surgical treatment even for complex cases of bullous keratopathy.

In a case series 9 eyes from 8 patients with chronic corneal edema caused by multiple intraocular operations underwent DMEK surgery. It was the sole surgical procedure in three eyes. In one case DMEK was combined with an intravitreal injection of bevacizumab, with opacified intraocular lens exchange in a second case, with transscleral cyclophotocoagulation with Iridex micropulse laser (Iridex, Silicon Valley, CA, USA) and intravitreal injection of bevacizumab in a third case and with the Tutopatch® (DMR srl, Italy) coverage of a scleral perforation in a fourth case. Additionally, DMEK was combined with trimming of the Ahmed valve tube length in two cases. The follow-up period was 12 months.

Out of 9 eyes 2 showed a persistent partial or total detachment of the graft with concomitant recurrence of bullous keratopathy despite repeated injection of 20% sulfur hexafluoride (SF6) in the anterior chamber. These 2 eyes were treated with penetrating keratoplasty and achieved satisfactory postoperative results including pain relief. Visual acuity did not improve in these 2 eyes due to optic atrophy. Visual acuity and pain improved in the first postoperative month in 7 eyes. Donor endothelial cell density decreased from 2465±147/mm² to 1295 ± 254/mm² and 1180 ± 197/mm² (p < 0.001, n = 7) after 6 and 12 months, respectively. Central corneal thickness decreased from 880 ± 232 μm to 571 ± 15 μm (p = 0.001, n = 7) after 12 months. Multiple rebubblings were performed in 2 of the 9 eyes because of a persistent corneal graft detachment.

Although DMEK is a technically demanding surgical treatment for complicated cases of severe bullous keratopathy, it provides satisfactory results in terms of the improvement of visual acuity, pain relief and a shorter postoperative period.