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

Abstract

Objectives To analyze the outcomes and complications of Descemet's Membrane Endothelial Keratoplasty (DMEK) performed without prophylactic peripheral iridotomy (PI). Methods Design: Retrospective study. Setting: institutional, tertiary care eye hospital Study Population: All patients who underwent DMEK or DMEK combined with phacoemulsification (DMEK triple) for Fuch's Endothelial Dystrophy, using a standardized protocol between Aug 2016 to July 2021, were included. Previous glaucoma surgery, laser PI, aphakia or complicated pseudophakia were excluded. Main Outcome Measures:Primary outcomes: incidence of the pupillary block (PB). Secondary outcomes: graft detachment (GD), rebubbling rates, uncorrected (UCDVA) & best corrected LogMAR distance visual acuity (BCDVA) and endothelial cell loss (ECL) at six months. Data were analyzed using the chi-square test and stepwise backward regression analysis. Results 104 eyes of 72 patients were included. Four eyes (3.8%) developed PB. In two of these cases of PB, standard protocol was not followed; in the other two, there was an inadequate release of gas and aqueous on day 1. Significant GD occurred in 7 eyes (6.6%), and rebubbling in theatre was needed in 4 eyes (3.8%). PB, GD and rebubbling rates did not vary with the surgeon, surgery, or tamponade (air or SF6 gas). UCDVA, BCDVA and ECL at 6 months were 0.29±0.31, 0.20±0.28 and 40.46±20.36%, respectively. Conclusions Compared to previously reported outcomes of DMEK with PI, our results of PI less DMEK using a standardized protocol have a similar incidence of pupillary block, graft detachment, and rebubbling, with comparable visual acuity and endothelial cell loss.