Rénuka S Birbal1, C Maya Tong2, Isabel Dapena3, John S Parker4, Jack S Parker5, Silke Oellerich6, Gerrit R J Melles7. 1. Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, Netherlands. 2. Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands; University of Alberta, Edmonton, Canada; NIIOS-USA, San Diego, California, USA. 3. Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, Netherlands. 4. Parker Cornea, Birmingham, Alabama, USA. 5. Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands; NIIOS-USA, San Diego, California, USA; Parker Cornea, Birmingham, Alabama, USA. 6. Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands. 7. Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, Netherlands; NIIOS-USA, San Diego, California, USA. Electronic address: research@niios.com.
Abstract
PURPOSE: To evaluate the feasibility and clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with a glaucoma drainage device (GDD). DESIGN: Retrospective, interventional case series. METHODS: Clinical outcomes of 23 DMEK procedures for bullous keratopathy (52%), failed previous transplant (39%), or Fuchs endothelial corneal dystrophy (9%) in 20 eyes (19 patients) with a GDD were retrospectively analyzed at 2 tertiary referral centers. Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD), postoperative complications, and graft survival. RESULTS: Mean length of postoperative follow-up after DMEK was 19 (±17) months. Kaplan-Meier survival analysis showed an 89% cumulative graft success rate at 1 year postoperatively. At 1 year postoperatively (n = 15 eyes), BCVA improved by ≥2 Snellen lines in 11 eyes (73%) and remained stable in 4 eyes (27%). Donor ECD decreased by 37% (n = 14), 60% (n = 11), and 71% (n = 11) at 1, 6, and 12 months postoperatively, respectively. Postoperative complications up to 2 years postoperatively comprised pupillary block in 1 eye (successfully reversed by partial air removal), visually significant graft detachment requiring rebubbling in 5 eyes (22%), allograft rejection successfully reversed with topical steroids in 2 eyes (9%), secondary graft failure in 2 eyes (9%), and cataract in 1 of 3 phakic eyes (33%). Re-keratoplasty was required in 2 eyes (9%). CONCLUSIONS: With specific surgical modifications, DMEK provided acceptable clinical outcomes when taking the complexity of these eyes into account. However, presence of a GDD may reduce graft survival times and may pose a risk for more frequent regrafting.
PURPOSE: To evaluate the feasibility and clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with a glaucoma drainage device (GDD). DESIGN: Retrospective, interventional case series. METHODS: Clinical outcomes of 23 DMEK procedures for bullous keratopathy (52%), failed previous transplant (39%), or Fuchs endothelial corneal dystrophy (9%) in 20 eyes (19 patients) with a GDD were retrospectively analyzed at 2 tertiary referral centers. Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD), postoperative complications, and graft survival. RESULTS: Mean length of postoperative follow-up after DMEK was 19 (±17) months. Kaplan-Meier survival analysis showed an 89% cumulative graft success rate at 1 year postoperatively. At 1 year postoperatively (n = 15 eyes), BCVA improved by ≥2 Snellen lines in 11 eyes (73%) and remained stable in 4 eyes (27%). DonorECD decreased by 37% (n = 14), 60% (n = 11), and 71% (n = 11) at 1, 6, and 12 months postoperatively, respectively. Postoperative complications up to 2 years postoperatively comprised pupillary block in 1 eye (successfully reversed by partial air removal), visually significant graft detachment requiring rebubbling in 5 eyes (22%), allograft rejection successfully reversed with topical steroids in 2 eyes (9%), secondary graft failure in 2 eyes (9%), and cataract in 1 of 3 phakic eyes (33%). Re-keratoplasty was required in 2 eyes (9%). CONCLUSIONS: With specific surgical modifications, DMEK provided acceptable clinical outcomes when taking the complexity of these eyes into account. However, presence of a GDD may reduce graft survival times and may pose a risk for more frequent regrafting.
Authors: Silvia Schrittenlocher; C Grass; T Dietlein; A Lappas; M Matthaei; C Cursiefen; B Bachmann Journal: Graefes Arch Clin Exp Ophthalmol Date: 2021-12-04 Impact factor: 3.117