Abstract
Purpose :
To analyze the feasibility of Descemet membrane endothelial keratoplasty (DMEK) for treatment of endothelial failure caused by primary angle closure.
Methods :
Retrospective, single-center case series of eyes treated by DMEK for endothelial failure caused by primary angle closure, and their contralateral eyes. Anterior segment morphology was examined preoperatively by Scheimpflug tomography (Pentacam® HR, OCULUS Optikgeraete GmbH, Wetzlar, Germany), and anterior segment optical coherence tomography (AS-OCT, Casia-2, Tomey GmbH). Calculation of the intraocular lens was performed using IOL-Master 500 (Carl Zeiss Meditec AG, Jena, Germany).
Results :
16 eyes of 8 patients were included in this analysis. Endothelial failure was present in 10 eyes at first presentation. Two patients presented with corneal edema after cataract surgery at another clinic. The other 8 eyes with corneal edema had no history of previous surgery. None of the patients had signs of corneal dystrophy or uveitis. The contralateral eyes of 6 patients had no edema, but were included for analysis of anterior segment morphology and endothelial cell density. All eyes except for two were phakic at time of presentation. DMEK with combined cataract surgery was performed in six eyes, DMEK alone with second-step cataract surgery in two eyes. The two eyes with corneal edema after cataract surgery received DMEK only. Two contralateral eyes without manifest corneal edema were treated with cataract surgery only. Preoperative endothelial cell density was 646/mm2 and 734/mm2, respectively, but no edema occurred during the follow-up time of three months. Mean axial length (IOL master) was 22.70 ± 0.57 (range 21.46 – 23.65 mm). In the group of phakic eyes, mean anterior chamber depth was 1.80 ± 0.36 mm (range 1.36 – 2.48 mm). DMEK surgery was successful in 90% of eyes (9 out of 10) without secondary graft failure.
Conclusions :
DMEK is a feasible option in eyes with endothelial failure due to primary angle closure. In case of advanced corneal edema, a second-step procedure (1st DMEK, 2nd cataract surgery) is a possible approach if visibility of the lens is too poor for simultaneous cataract surgery. Furthermore, cataract surgeons should be aware of possible reduced corneal endothelial cell density in eyes with axial length < 22.70 mm and preoperative anterior chamber depth of <1.80 mm.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.