Descemet Membrane Endothelial Keratoplasty for Corneal Decompensation Secondary to Phakic Intraocular Lenses

Abstract

Purpose To describe the surgical technique and clinical outcomes of bilensectomy (pIOL explant and phacoemulsification), followed by DMEK performed for bullous keratopathy secondary to pIOL. Methods Seven eyes of seven patients, who developed corneal decompensation after pIOL implantation, underwent bilensectomy followed by DMEK in a two-step procedure. Main outcome measures included uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), refraction, endothelial cell density (ECD) at 1, 3, 6, and 12 months, and intraoperative and postoperative complications. Results DMEK was performed at a mean time of 9.83 ± 8.23 months after bilensectomy. BCVA (log MAR) improved in all eyes, increasing from 1.11 ± 0.78 preoperatively to 0.54 ± 0.21, 0.28 ± 0.23, 0.21 ± 0.21, and 0.17 ± 0.17 at 1, 3, 6, and 12 months after DMEK. One year after surgery, mean spherical equivalent and cylinder were −0.70 ± 0.92 D and −1.50 ± 0.54 D, respectively. ECD decreased by 62 ± 4%, 69 ± 4%, 74 ± 4%, and 77 ± 3% at 1, 3, 6, and 12 months after DMEK. There was one case of primary graft failure and no other postoperative complications. Conclusions The two-step technique bilensectomy followed by DMEK is a feasible technique for the management of bullous keratopathy secondary to pIOL, providing a fast visual recovery with good visual and refractive results.

Descemet’s Membrane Endothelial Keratoplasty for Corneal Endothelial Failure Secondary to Three Types of Phakic Intraocular Lens – Retrospective Study

“…Our EC loss rates were considerably lower than those of a previous study. 12 However, our 2-year EC loss was somewhat higher than the reported average of 48%±16% (although within this range) of a recently published model of EC loss following DMEK. 27 Besides, these rates appear to be higher compared with our own results for DMEK for other indications, 15 , 19 as well as with medium-term DMEK studies, where reported %ECL 4 to 5 years after DMEK ranged between 48% and 59%.…”

“…In our study, DMEK proved feasible in the setting of PIOL-related corneal decompensation, in line with previous reports. 11 , 12 Although some authors have advocated simultaneous PIOL explantation and EK, 13 we consider that a staged approach is preferable in this setting for two main reasons: 1) the risk of intraoperative bleeding during explantation which would complicate DMEK surgery; and 2) in less severe cases we believe that if the PIOL explantation (± RLE) procedure is uneventful, some patients may retain sufficiently acceptable BCVA to delay or prevent DMEK surgery. In the study of López et al, 12 only one case underwent quadruple procedure (simultaneous PIOL explantation + cataract surgery + DMEK), and it ended in PGF, which supports our notion that a two-staged approach may be preferable.…”

Long-term results of Descemet-stripping automated endothelial keratoplasty for endothelial failure caused by phakic intraocular lenses

“…Besides, our refractive results looks quite similar compared to DMEK cases (SE: −0.97 (1.09) D -without phakic eyes -vs −0.70 (0.92) D; Cylinder: −1.70 (0.63) D vs −1.50 (0.54) D). 18 We may then conclude that a visual rehabilitation strategy that includes DSAEK as the procedure of choice allowed long-term stable visual performance.…”

“…At 12 months mean BCVA ranged from 0.00 to 0.3 logMAR and 80% of patients had a BCVA ⩽ 0.3 log-MAR. Most recently, López and Martínez 18 reported their 12-months outcomes on seven eyes with bullous keratopathy due to pIOL (four iris-claw and three angle-supported) in which bilensectomy followed by DMEK was performed (quadruple procedure with DMEK was done only in one eye). Mean BCVA was 0.17 (0.17) at 12-months, with 83.3% of the eyes with a BCVA ⩽ 0.3 log-MAR.…”

Long-Term Follow-Up of Corneal Endothelial Cell Changes After Iris-Fixated Phakic Intraocular Lens Explantation

“…Although this was just 1 case, when ophthalmologists are faced with corneal decompensation after pIOL removal, DMEK might become a common surgical solution for surgeons as previously reported. 24…”