Endothelium-In Pull-Through Descemet Membrane Endothelial Keratoplasty for Bullous Keratopathy in Vitrectomized Eyes

Descemet membrane endothelial keratoplasty (DMEK) is the preferred treatment for corneal endothelial dysfunction; nonetheless, its feasibility and outcomes in vitrectomized eyes remain uncertain. We evaluated the outcomes and surgical considerations of endothelium-in pull-through DMEK in vitrectomized eyes with bullous keratopathy.

Eight vitrectomized eyes from eight patients (mean age, 71.9 ± 15.4 years; mean follow-up, 4.9 ± 1.6 months) underwent endothelium-in pull-through DMEK using the EndoGlide between August 2023 and October 2024. Best spectacle-corrected visual acuity, endothelial cell density, central corneal thickness, and complications were recorded.

In 5 eyes (62.5%), the graft unfolded smoothly; in 3 eyes (37.5%), excessive unfolding required conversion to an endothelium-out roll using the double-bubble technique. All grafts attached without rebubbling. The best spectacle-corrected visual acuity improved from 1.00 logMAR (interquartile range, 0.65-1.10) preoperatively to 0.30 (0.13-0.55) and 0.40 (0.15-0.52) logMAR at 3 and 6 months, respectively (Wilcoxon, both P < 0.05). The central corneal thickness decreased from 693.5 µm (640-788.8) to 522.5 µm (502.3-564.3) and 549 µm (542-577) at 3 and 6 months, respectively (Wilcoxon, both P < 0.05). The endothelial cell density decreased from 2737 cells/mm 2 (2540-2928) preoperatively to 2412 cells/mm 2 (2284-2610) and 2238 cells/mm 2 (2086-2245) at 3 and 6 months, respectively; at the final follow-up, the median cell density was 2288 cells/mm 2 (2200-2428), representing a 16.4% loss relative to the donor value.

Endothelium-in pull-through DMEK is feasible in vitrectomized eyes, achieving stable attachment with visual and anatomical improvement even when adjunctive maneuvers are required, demonstrating clinical utility in postvitrectomy corneal edema.