Patient comfort and visual acuity after EndoArt implantation for decompensated endothelium in glaucoma patients.

Abstract

Purpose : We report results after implantation of the novel posterior keratoprosthesis EndoArt (EyeYon Medical, Israel) for endothelial replacement in glaucoma patients. These patients are at high risk for graft failure after DMEK. EndoArt acts as a barrier for aqueous humor and might allow stabilization of the corneal edema without the risk of rejection.

Methods : 12 Glaucoma patients after implantation of EndoArt were retrospectively analyzed. The prosthesis was positioned on the posterior stroma and secured by a gas bubble and sutures. We measured visual acuity and asked about changes in patients' comfort after the implantation of EndoArt especially in foreign body sensation, glare, or tearing on a scale from 0 to 10 (10 being the worst, 0 being no complaints) before and 2-4 months after surgery.

Results : A consecutive series of 12 advanced glaucoma patients were included in this analysis. All patients had undergone multiple glaucoma surgeries (including drainage device implantation in 7 patients), and some up to 5 DMEK procedures. 10 eyes were pseudophakic, and 2 were aphakic. 9 patients received C3F8 12%, and 3 received SF6 20% for the attachment of EndoArt.
Mean preoperative visual acuity was logMAR 1.5 (± 0.6). Only after 7-12 weeks postoperatively, the mean visual acuity improved to 1.2 (± 0.8). Preoperatively, patients complained of discomfort, foreign body sensation/pain, tearing and glare. All patients reported a decrease of these symptoms. When asked for grading tearing was given 2.6 (± 3.9) preoperatively and 0.9 (± 1.5) postoperatively, glare 4.1 (± 3.8) preoperatively and 2.66 (± 2.7) postoperatively and foreign body sensation and pain reached 32.5 (± 3.9) preoperatively and 0.7 (± 1.3) postoperatively. The most common complaint before surgery was glare, then pain.
6 eyes needed at least one rebubbling, 3 eyes needed two, and one eye received three rebubblings. 2 patients who needed repetitive rebubbling initially received SF6 20% and 2 C3F8 12%. The patient who needed 3 rebubblings repetitively received SF6 20%.

Conclusions : EndoArt led to an delayed improvement in visual acuity, and increased patient comfort. The major complication after EndoArt implantation was implant detachment requiring rebubbling. The use of C3F8 12% improves the rebubbling rate. Patients at high risk for graft failure after DMEK may benefit from this novel treatment option.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.