“Tissue-sparing” approach in Descemet’s Membrane Endothelial Keratoplasty using pupil-dilating eye drops

Abstract

Purpose : To assess clinical outcomes after Descemet’s Membrane Endothelial Keratoplasty (DMEK) using mydriatic eye drops without peripheral iridectomy (PI). We performed a retrospective, observational clinical study to evaluate the postoperative intraocular pressure (IOP) changes and graft viability in a cohort of Fuchs’ endothelial corneal dystrophy (FECD) patients.

Methods : Included in this study were pseudophakic DMEK patients with FECD (n=23). The mean follow-up period of the 12 female and 11 male patients was 3.7 month (mean: 71 years; range: 54-88 years). Pseudophakic FECD eyes after DMEK with peripheral iridectomy served as control (n=10). Inclusion criteria: air as tamponading agent, physiological air resorption and inpatients without ocular comorbidities. Mydriatic eye drops were administered 4x/d for three days. Best-corrected visual acuity (BCVA), endothelial cell density (ECD), central corneal thickness (CCT) and IOP were assessed. Intra- and postoperative adverse events, type and timing of interventions were registered. Statistical analyses were performed using Microsoft Excel and IBM SPSS. Research was conducted in compliance with an accredited Institutional Review Board.

Results : BCVA improved from 0.52±0.27 logMAR to 0.11±0.15 logMAR (p=0.005; control: 0.61±0.2 logMAR to 0.17±0.16 logMAR). CCT decreased from 647±44 µm to 538±27 µm (p=0.130; control: 642±104 µm to 475±41 µm) and ECD from 2400±166 cells/mm² to 1966±509 cells/mm² (p=0.182; control: 2520±235 cells/mm² to 1718±355 cells/mm²). Mean preoperative IOP was 14±3 mmHg (control:14±3 mmHg); mean postoperative IOP was 19±12 mmHg, 14±5 mmHg, 11±3 mmHg and 11±3 mmHg at day of surgery (p=0.06), day 1, 2 and 3, respectively (control:15±4 mmHg, 13±4 mmHg, 11±3 mmHg and 11±2 mmHg, respectively). No intraoperative adverse events occurred. As postoperative adverse events graft detachment (n=6; control:n=1) and IOP decompensation necessitating an emergent air release (n=1;control:n=0) were noted. As interventions re-bubbling and re-re-bubbling were performed (N=6 and 3; 11±8 days and 14±11 days, respectively). No grafts failed.

Conclusions : This study showed feasibility of DMEK without PI with respect to postoperative IOP developments and graft viability using medical prophylaxis for IOP regulation. Close postoperative IOP monitoring is advised.

This is a 2020 ARVO Annual Meeting abstract.