Descemet membrane endothelial keratoplasty in complex eyes

Abstract

Purpose of reviewTo review the current literature on Descemet membrane endothelial keratoplasty (DMEK) in complex eyes.Recent findingsDMEK surgery has become a standardized procedure in Fuchs endothelial dystrophy and simple bullous keratopathy. But eyes with more complex disease present unique intraoperative and postoperative challenges to the DMEK surgeon. Poor visualization during surgery, complex anterior segment anatomy, altered anterior chamber dynamics, glaucoma shunts, and congenital or iatrogenic missing or altered iris and lens make DMEK surgery extremely difficult to accomplish.SummaryDMEK is feasible in complex eyes, including advanced bullous keratopathy, eyes with history of glaucoma or vitreoretinal surgery, previous penetrating keratoplasty, uveitis, pediatric, and congenital anterior segment disorders. The tools and methods reported in the literature to accomplish DMEK in complex eyes vary widely with no particular consensus or standardization of techniques. The outcomes noted for some of these conditions demonstrate the difficulty of the surgery and the uncertainty of long-term graft survival in complex eyes. Both surgical standardization and randomized prospective data will better help elucidate DMEK's role in the corneal rehabilitation of complex eyes.

Suture Fixation to Reduce Graft Detachment in Descemet Stripping Endothelial Keratoplasty

“…DMEK in these complex eyes can be technically challenging given shifts in anterior chamber dynamics, inability to retain an anterior chamber bubble, and poor graft visualization. 40 The authors here would argue that the technical difficulty of suturing a DSEK graft with our described method is a flatter learning curve compared with performing DMEK in these complex eyes. Certainly, our limited data on early failure and 12-months survival are inadequate to settle this debate, yet our very low detachment rate is an important factor to consider.…”

Outcomes of Corneal Transplant in Childhood Glaucoma

“…Although PK has been the technique most widely used to treat corneal endothelial failure in pediatric transplantations, 49 recently other techniques such as anterior or posterior lamellar keratoplasties have been used with success 30–37 . In the Corneal Preservation Time Study, 50 eyes that had undergone surgery for glaucoma had a lower 3-year graft success rate after DSAEK (80.1% vs 94.1% for eyes without glaucoma surgery) 50 .…”

“…Although PK has been the technique most widely used to treat corneal endothelial failure in pediatric transplantations, 49 recently other techniques such as anterior or posterior lamellar keratoplasties have been used with success. [30][31][32][33][34][35][36][37] In the Corneal Preservation Time Study, 50 eyes that had undergone surgery for glaucoma had a lower 3year graft success rate after DSAEK (80.1% vs 94.1% for eyes without glaucoma surgery). 50 However, the subgroups with glaucoma surgery alone, those with prior surgery and medication, and those with medication alone were too small to conduct further analyses on different factors that could influence subsequent graft success.…”

“…Until recent years, the most widely used technique to treat corneal endothelial failure in pediatric patients was penetrating keratoplasty (PK) (Kim and colleagues, 2018). Recently, however, other posterior lamellar techniques such as Descemet stripping automated endothelial keratoplasty (DSAEK) or Descemet membrane endothelial keratoplasty (DMEK) have been used with success in pediatric patients 30–37 . Various studies have analyzed the results of corneal transplantation in pediatric patients, but have not dealt specifically with its results in pediatric glaucoma patients 38–41 .…”

“…Recently, however, other posterior lamellar techniques such as Descemet stripping automated endothelial keratoplasty (DSAEK) or Descemet membrane endothelial keratoplasty (DMEK) have been used with success in pediatric patients. [30][31][32][33][34][35][36][37] Various studies have analyzed the results of corneal transplantation in pediatric patients, but have not dealt specifically with its results in pediatric glaucoma patients. [38][39][40][41] Therefore, the aim of the present study is to evaluate the results of corneal transplantation in patients diagnosed with childhood glaucoma.…”