Descemet Membrane Endothelial Keratoplasty in Pseudophakic Bullous Keratopathy: Outcomes and Evidence-Based Suggestions
AbstractThe purpose of the study was to determine clinical outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) in patients with Pseudophakic Bullous Keratopathy (PBK). The study was conducted at a tertiary referral center. This was a retrospective case series. Pseudophakic eyes having undergone DMEK surgery for Pseudophakic Bullous Keratopathy was considered the object of study. The examination implied the analysis of best corrected visual acuity (BCVA or CDVA), endothelial cell density (ECD), intraocular pressure (IOP), intraoperative and postoperative complications and a follow-up in 1, 3, and 6 months. For the purposes of the study, 25 pseudophakic eyes with PBK were examined. One month after the surgery patients reached a BCVA of 0.49±0.08(M±SD), after 3 months - BCVA of 0.65±0.12(M±SD), and a BCVA of 0.78±0.17 (M±SD) in the last follow-up in 6 months after the surgery (P<0,001). The mean ECD after one month was 1661±133 (M±SD) cells/mm2, after 3 months - 1591±124 (M±SD) cells/mm2, and during the last control in 6 months -1579±128 (M±SD) cells/mm2. The graft detachment rate was 12% (3 cases). Hypertension was observed in one eye (4%), necessitating partial air elimination through a corneal wound within the first hours after the surgery. DMEK may give excellent visual results in Pseudophakic eyes without increasing the risk of complications when compared to Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) and Penetrating Keratoplasty (PKP). Anatomic repair after DMEK is associated with improved corneal clarity and BCVA.
Kumar. In: Robbins and cotran: Pathological basis of disease. 7th ed. Kumar, editor. Saunders; 2005.
Edelhauser HF. The balance between corneal transparency and edema the proctor lecture. Invest Ophthalmol Vis Sci. 2006;47:1755–67.
Bourne RR, Minassian DC, Dart JK, Rosen P, Kaushal S, Wingate N. Effect of cataract surgery on the corneal endothelium: Modern phacoemulsification compared with extracapsular cataract surgery. Ophthalmology. 2004;111:679–85.
Borboli S, Colby K. Mechanisms of disease: Fuchs’ endothelial dystrophy. Ophthalmol Clin North Am. 2002;15:17–25.
Fernandez MM, Afshari NA. Endothelial Keratoplasty: From DLEK to DMEK. Middle East African Journal of Ophthalmology. 2010;17(1):5-8.
Takahashi H. Corneal Endothelium and Phacoemulsification. Cornea. 2016 Nov;35 Suppl 1:S3-S7.
Derek W. DelMonte, MD, Terry Kim, MD. Anatomy and physiology of the cornea. J Cataract Refract Surg 2011; 37:588–598.
Shimazaki J, Amano S, Uno T, Maeda N, Yokoi N, and the Japan Bullous Keratopathy Study Group. National survey on bullous keratopathy in Japan. Cornea 2007; 26:274– 278
Goncalves ED, Campos M, Paris F, Gomes JA, Farias CC. Bullous keratopathy: etiopathogenesis and treatment. Arq Bras Oftalmol. 2008;71(6 Suppl):61–64.
Gomes JA, Haraguchi DK, Zambrano DU, Izquierdo Junior L, Cunha MC, de Freitas D. Anterior stromal puncture in the treatment of bullous keratopathy: six-month follow-up. Cornea.2001;20(6):570–2.
Uchino Y, Goto E, Takano Y, et al. Long-standing bullous keratopathy is associated with peripheral conjunctivalization and limbal deficiency. Ophthalmology. 2006;113(7):1098–1101.
Spaniol K, Holtmann C, Schwinde JH, Deffaa S, Guthoff R, Geerling G. Descemet-membrane endothelial keratoplasty in patients with retinal comorbidity-a prospective cohort study. Int J Ophthalmol. 2016 Mar 18;9(3):390-4.
Patel SV. Graft survival and endothelial outcomes in the new era of endothelial keratoplasty. Exp Eye Res 2012;95:40–7.
Tourtas T, Laaser K, Bachmann BO, et al. Descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 2012;153:1082–90.
2011 Eye Banking Statistical Report. Eye Bank Association of America. Washington DC; 2010.
Dapena I, Moutsouris K, Droutsas K, Ham L, van Dijk K, Melles GR. Standardized “no-touch” technique for Descemet membrane endothelial keratoplasty. Arch Ophthalmol 2011;129:88–94.
Parker J, Dirisamer M, Naveiras M, et al. Outcomes of Descemet membrane endothelial keratoplasty in phakic eyes. J Cataract Refract Surg. 2012 May;38(5):871-7.
Phillips PM, Phillips LJ, Muthappan V, Maloney CM, Carver CN. Experienced DSAEK Surgeon's Transition to DMEK: Outcomes Comparing the Last 100 DSAEKSurgeries With the First 100 DMEK Surgeries Exclusively Using PreviouslyPublished Techniques. Cornea. 2017 Mar;36(3):275-279.
Aravena C, Yu F, Deng SX. Outcomes of Descemet Membrane Endothelial Keratoplasty in Patients With Previous Glaucoma Surgery. Cornea. 2017Mar;36(3):284-289.
Ang M, Mehta JS, Newman SD, Han SB, Chai J, Tan D. Descemet Membrane Endothelial Keratoplasty: Preliminary Results of a Donor Insertion Pull-through Technique Using a Donor Mat Device. Am J Ophthalmol. 2016 Nov;171:27-34.