Descemet Membrane Endothelial Keratoplasty in Pseudophakic Bullous Keratopathy: Outcomes and Evidence-Based Suggestions

Abstract

The 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/mm^2, 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.