Novel Technique for Improving Graft Unfolding in Vitrectomized Eyes Using a Temporary Diaphragm in Descemet Membrane Endothelial Keratoplasty

• Published in: Cornea
• Main Authors: Yoeruek, Efdal, Bartz-Schmidt, Karl U
• Format: Journal Article
• Language: English
• Published: United States 01.10.2018
• ISSN: 1536-4798
• DOI: 10.1097/ICO.0000000000001614

To describe a new surgical technique for performing Descemet membrane endothelial keratoplasty (DMEK) using a temporary hydrophilic methacrylate sheet in the anterior chamber in cases of previous vitrectomy with complete removal of the vitreous body. Medical records were reviewed for baseline and follow-up best spectacle-corrected visual acuity, endothelial cell count, and indication for DMEK using a temporary hydrophilic methacrylate sheet. Operative notes were analyzed in all cases to identify any specific intraoperative event. Seven eyes of 7 patients were included in this analysis. Mean age was 65.7 ± 18.2 years, and the mean follow-up duration was 11.5 months. All 7 patients had previously received pars plana vitrectomy with complete vitreous removal. All patients were pseudophakic. For 5 patients, it was their first DMEK surgery and 2 patients had DMEK surgery for a second time, due to a failed outcome in previous surgery. Best spectacle-corrected visual acuity improved from 1.5 ± 0.5 logMAR before surgery to 0.76 ± 0.37 logMAR after surgery during follow-up (P < 0.001). The mean endothelial cell count was 2442 ± 304 cells/mm and decreased to 1484 ± 279 cells/mm during follow-up (P < 0.001). No complications were observed in any of the cases at the unfolding stage using this method. All grafts remained clear at the last follow-up visit. This modified approach of DMEK surgery, using a temporary hydrophilic methacrylate sheet for flattening the anterior chamber and facilitating graft unfolding, could help overcome possible complications of DMEK in completely vitrectomized eyes.