Effects of uncomplicated Descemet membrane endothelial keratoplasty on the central retinal thickness

Abstract

Purpose To determine retinal thickness (RT) changes and the incidence of macular edema after uncomplicated Descemet membrane endothelial keratoplasty (DMEK-ME) in patients without ME risk factors. Methods In this retrospective study, 107 pseudophakic eyes of 74 patients with Fuchs endothelial dystrophy (FED) (79.4%) or bullous keratopathy (BK) (20.6%) underwent DMEK surgery between 2016 and 2019 at the Department of Ophthalmology, RWTH Aachen University. Patients with intra- or postoperative complications as well as pre-existing risk factors for ME were excluded. Macular spectral-domain optical coherence tomography (SD-OCT) and best spectacle-corrected visual acuity (BSCVA) measurements were performed before, 1 week, 1 month, and 6 months after surgery. Retinal thickness (RT) was analyzed in the central foveal 1 mm (CSF), parafoveal 3 mm and 6 mm subfield. Results Eight eyes (7.5%) developed DMEK-ME 1 month after surgery. Six DMEK-ME eyes (75%) were rebubbled, compared with 31.3% (31 of 99; P = 0.02) of the non DMEK-ME eyes. DMEK-ME eyes had a significantly thicker CSF 1 month after surgery (432.0 ± 97.6 μm) compared with non-DMEK-ME eyes (283.7 ± 22.2 μm; P = 0.01). The other subfields and time points showed no significant RT changes. DMEK-ME significantly impaired BSCVA (0.38 ± 0.92 logMAR) only 1 month after surgery in comparison to the non DMEK-ME eyes (0.23 ± 0.87 logMAR, P = 0.015). Conclusion Excluding systemic and surgery-related risk factors, rebubbling increases the risk of DMEK-ME. Performing a CSF scan 1 month after surgery, particularly in rebubbled eyes, efficiently detects DMEK-ME and allows the prompt initiation of treatment, e.g., topical corticosteroid and non-steroidal (NSAID) eye drops.

Outcomes of cystoid macular edema following Descemet’s membrane endothelial keratoplasty in a referral center for keratoplasty in Spain: retrospective study

“…In our study, we have found that 60% of eyes had subretinal fluid in addition to intraretinal fluid cysts, higher compared with the reported incidence in previous studies 19,20 ; we have observed no cases of isolated SRF, in agreement with the study by Flanary et al 5 . The pathophysiologic mechanisms underlying postoperative CMO after EK is similar to that of pseudophakic CMO, with the additional release of inflammatory mediators due to iris manipulation by iridectomy and intracameral gas tamponade; one study found that iris damage before and after DMEK increased the risk of post-DMEK CMO 9 , and preoperative LASER iridotomy may be associated with a lower risk of post-EK CMO 21 .…”

“…In our study, three eyes had history of DMEK in the fellow eye, however we do not believe that DMEK in the fellow eye was a contributing factor for vs-CMO after DMEK in the second eye 4,8 . Two eyes needed rebubbling after DMEK; while it is conceivable that rebubbling may increase the risk of post-EK CMO due to repeated manipulation and resulting in increased release of prostaglandins and other inflammatory mediators 9,20,26 , this association has been disputed by other studies 3,4,6,8,19 .…”

“…In our study, most cases of vs-CMO developed during the first postoperative month after DMEK, and all cases developed vs-CMO within 6 months after DMEK. Reported average times to detection of post-EK CMO range from 5.2 weeks and 4.3 months [4,6,19,26], with most cases appearing within the first month of surgery 3,5,9,20,24 . A standardized management protocol for postoperative CMO following EK is currently lacking.…”

Descemet Membrane Endothelial Keratoplasty and Triple Descemet Membrane Endothelial Keratoplasty in Eyes With Macular Comorbidity

“…In contrast to our study, focus was set on a larger area of the macula concerning CRT, but authors suggested that the central 1-mm zone was most sufficient due to the lack of significant differences between the 2 groups in the 3-and 6-mm subfield. 16 In summary, our study shows that even in the known or suspected presence of macular comorbidities, DMEK and triple DMEK substantially improve BCVA. However, when deciding to list a patient with macular pathologies for corneal transplantation, the potential visual limitations should be carefully discussed with the patient to set realistic expectations because the BCVA outcome was significantly worse in this subgroup.…”

“…In contrast to our study, focus was set on a larger area of the macula concerning CRT, but authors suggested that the central 1-mm zone was most sufficient due to the lack of significant differences between the 2 groups in the 3- and 6-mm subfield. 16…”