Descemet’s membrane endothelial keratoplasty (DMEK) is successful in restoring visual acuity in vitrectomized eyes, says a new study published in the January 2015 Cornea.1 However, graft failure and the overall complication rate are both higher than in standard DMEK procedures.
Researchers at Eberhard-Karls University, in Tubingen, Germany, reviewed 20 cases of DMEK surgery; seven of these eyes had a history of anterior vitrectomy and 13 eyes had a history of complete removal of the vitreous body. Subjects ranging in age from 37 to 78 years were evaluated the day before surgery, on the day of surgery and during the first, second and fourth week after the procedure. Additional three-month follow-up exams occurred after the initial first month.
EK can improve visual acuity even in vitrectomized eyes. Photo: Aaron Bronner, OD
Following surgery, researchers reported an improvement in best-corrected visual acuity from 1.4 (± 0.5) logMAR (20/500) preoperatively to 1.0 (± 0.5) logMAR (20/200) at four weeks. Subsequent improvement to 0.8 (± 0.6) logMAR (20/125) at six months, and to 0.6 (± 0.3) logMAR (20/80) at 12 months, were also observed, despite the presence of comorbidities, including age-related retinal disease, glaucoma, corneal scarring and total retinal detachment.
Even with surgical success, however, complications occurred in 13 of the 20 eyes. Graft dislocation occurred in 11 cases, requiring surgical intervention consisting of one or more additional air injections. In the immediate postoperative period, two eyes experienced iatrogenic primary graft failure, while four eyes had late graft failure.
Other complications included exacerbation of pre-existing glaucoma and intraocular pressure elevation of up to 40mm Hg during follow-up in two eyes. “With more experience, probably better results could be achieved in vitrectomized eyes,” the authors concluded.
1. Yoeruek E, Rubino G, Bayyoud T, Bartz-Schmidt KU. Descemet membrane endothelial keratoplasty in vitrectomized eyes: clinical results. Cornea. 2015 Jan;34(1):1-5.