Clinical Outcomes of Descemet Membrane Endothelial Keratoplasty in Pseudophakic Eyes Compared With Triple-DMEK at 1-Year Follow-up

Abstract

Purpose: To compare the survival rate 1 year after Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic eyes versus combined phacoemulsification and DMEK (triple-DMEK). Methods: Retrospective, interventional, consecutive case series. From all DMEKs performed from January 1, 2017, to June 30, 2018, we selected those performed in pseudophakic eyes (pseudophakic DMEK) and those that underwent triple-DMEK. We compared the survival rate 1 year after surgery between both groups and between the Fuchs endothelial dystrophy (FED) cases in both groups, plus the FED cases versus the pseudophakic bullous keratopathy (PBK) cases in the pseudophakic DMEK group. Second, we compared rebubbling rates and the influence of the use of gas or corneal sutures on rebubbling and dislocation rates. Results: A total of 329 eyes were included (218 eyes pseudophakic DMEK and 111 eyes triple-DMEK). The survival rate at 1 year was 79.8% and 90%, respectively (P = 0.03). When only FED cases were included (133 pseudophakic DMEK and 108 triple-DMEK), no significant difference was found (87.9% vs. 90.7%, P = 0.59). Within the pseudophakic DMEK group, the survival rate was higher in FED cases (87.8%) compared with PBK cases (66.6%) (P = 0.0001). Rebubbling rates were 21.1% (pseudophakic DMEK) and 17.1% (triple-DMEK) (P = 0.39). The use of gas versus air or placing corneal sutures did not seem to influence the rebubbling (P = 0.64 and P = 0.13, respectively) or dislocation rates (P = 0.71 and P = 0.53, respectively). Conclusions: In the FED cases, performing phacoemulsification before DMEK or doing a combined procedure did not seem to affect the rebubbling or survival rate up to 1 year postoperatively. PBK was associated with a higher failure rate compared with that of FED.

Effects of Combined Cataract Surgery on Outcomes of Descemet's Membrane Endothelial Keratoplasty: A Systematic Review and Meta-Analysis

“…Seven non-randomized studies ( n = 1,414 eyes) reported the primary graft failure rate, which was similar between DMEK and “triple DMEK” (RD 0.01; 95% CI: −0.02 to 0.05; I 2 = 34%; p = 0.44; Figure 7A ) ( 21 , 34 , 35 , 43 – 45 , 48 ). There was no data available regarding primary graft failures among non-comparative DMEK and “triple DMEK” studies.…”

“…Eight comparative studies ( n = 2,799 eyes), which included 1,408 DMEK eyes and 1,391 “triple DMEK” eyes, reported the postoperative re-bubbling rate ( 21 , 22 , 34 , 35 , 39 , 43 , 45 , 48 ), Re-bubbling was reported in 316 (22.4%) DMEK eyes and 381 (27.4%) “triple DMEK” eyes. The meta-analysis demonstrated that there was no statistical difference between DMEK alone and “triple DMEK” in terms of postoperative re-bubbling rate (RD −0.06; 95% CI: −0.13 to 0.00; I 2 = 73%; p = 0.07; Figure 4A ).…”

Comparison of triple-DMEK to pseudophakic-DMEK: A cohort study of 95 eyes

“…It is possible that with a larger sample size, this value would have become significant. The literature regarding this issue is discordant: some studies found that triple-DMEK associates with higher levels of postoperative graft detachment [ 41 – 43 ] whereas others did not observe that triple-DMEK associates with worse rebubbling rates [ 28 , 30 , 44 , 45 ]. Again, the reason for these discrepancies is unclear but it may relate to differences between studies in terms of surgical factors.…”

Clinical outcomes of Descemet's membrane endothelial keratoplasty without routine prophylactic peripheral iridotomy

“…It was recorded as either mild (involving less than one-third of the peripheral graft area) or signi cant (involving more than one-third of the graft area or any detachment involving the central visual axis). 4,7 Surgical technique All grafts were prepared by the surgeon in the theatre before the surgery on the same day using a manual dissection technique with modi cations to the originally described method by Melles. 9 Following trephination and creation of a triangular mark to identify the correct orientation 10 , they were transferred into a single-use cartridge connected to tubing and syringe (Geuder injector system; German Geuder AG) just before transplantation.…”

“…To prevent this, surgeons often do prophylactic peripheral iridotomy either before, using the Nd-YAG laser or surgical iridectomy during the procedure; despite that, air or gas often needs to be released. [6][7][8] We have been routinely performing DMEK without preoperative PI or intraoperative surgical iridectomy using a standardized protocol for many years. This retrospective study aims to analyze whether avoiding laser iridotomy or surgical iridectomy affects the rates of pupillary block, graft detachment, graft failure and endothelial cell loss compared to those documented in the literature.…”