&lt;p&gt;Surgery-induced iris abnormalities after Descemet membrane endothelial keratoplasty and their impact on postoperative clinical outcomes&lt;/p&gt;

Mori, Natsuko; Yokogawa, Hideaki; Kobayashi, Akira; Nishino, Tsubasa; Sugiyama, Kazuhisa

doi:10.2147/opth.s196906

Cited by 5 publications

(3 citation statements)

References 18 publications

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“… 29 In general, a DMEK graft is clinically stained with 0.06% trypan blue for about 30 seconds to 5 minutes before transplantation. 23 , 31 , 41 This usually allows the surgeon to clearly visualize the donor tissue in the recipient anterior chamber and exhibits no endothelial toxicity. Nevertheless, in this study, a 3-minute stain with 0.1% trypan blue was chosen because our patients had a dark iris and most of them had long-standing corneal edema, further compromising intraoperative graft visualization.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand

Lekhanont¹,

Pisitpayat²,

Cheewaruangroj³

et al. 2021

OPTH

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Purpose To investigate the medium-term clinical outcomes and risk factors for primary graft failure after Descemet membrane endothelial keratoplasty (DMEK) in Thai patients. Patients and Methods This is a single-center retrospective cohort study. Sixty-two eyes of 62 patients who underwent DMEK at Ramathibodi Hospital, Bangkok, Thailand, with a minimum of 24-month follow-up were recruited. Preoperative donor and recipient characteristics, intraoperative data, and postoperative outcomes including best-corrected visual acuity (BCVA), graft clarity, endothelial cell density (ECD), central corneal thickness (CCT), and complications were evaluated at 1, 3, 6, 12, and 24 months after surgery. Results The mean age of the patients was 67.2 ± 9.9 years, and 52% were female. The mean follow-up time was 37.5 ± 11.0 months. The most common indications for DMEK were Fuchs’ endothelial corneal dystrophy (FECD) (53.2%) and pseudophakic bullous keratopathy (PBK) (17.7%). Nearly half of patients had triple-DMEK. The median preoperative BCVA was 20/400. Postoperative BCVA of ≥ 20/40 was reached in 37.1% and of ≥ 20/20 in 6.5% after 1 month which increased to 54.8% and 17.7% after 3 months; and to 67.7% and 27.4% after 24 months. Endothelial cell loss (ECL) at 3, 6, 12, and 24 months was 30.5%, 33.8%, 44.4%, and 45.9%, respectively. Graft diameter was the single factor, showing a significant relationship with postoperative ECD. Most frequent postoperative complications included graft detachment (22.6%), increased IOP/glaucoma (17.7%), and primary graft failure (16.1%). In univariate analysis, death-to-operation time and the diagnosis of PBK were significantly associated with the occurrence of primary graft failure. Conclusion DMEK is a safe, effective, and feasible treatment for endothelial failure in Asian eyes. Careful case selection, use of relatively fresh donor tissues, and appropriate surgical techniques can prevent primary graft failure and facilitate optimal outcomes following surgery.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand

Lekhanont¹,

Pisitpayat²,

Cheewaruangroj³

et al. 2021

OPTH

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“…In this study, we excluded any patient with previous intraocular surgery or conditions that could complicate the surgery. In DMEK surgery, iris involvement, which causes subjective pain is common, 22 may be increased in complicated conditions such as a shallow anterior chamber. In addition, inadvertent ocular movements could further complicate the surgery.…”

Section: Discussionmentioning

confidence: 99%

Use of topical anaesthesia and peribulbar anaesthesia in Descemets membrane endothelial keratoplasty

Pilger

Maier

Bertelmann

et al. 2020

European Journal of Ophthalmology

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Introduction: In instances where peribulbar anaesthesia (PBA) cannot be used, Descemet membrane endothelial keratoplasty (DMEK) surgery can be performed under topical anaesthesia (TA). We evaluated subjective pain and post-operative outcomes of DMEK surgeries performed under PBA and TA. Methods: Sixty pseudophakic patients without history of ocular comorbidities underwent DMEK surgery under either PBA or TA. PBA was performed with a single injection of 6 mL Prilocaine Hydrochloride 2% in combination with 1500 I.U. hyaluronidase. For TA, patients were given 0.4% Oxybuprocaine eye drops followed by a 2% Lidocain Hydrochloride-Gel and an intraoperative injection of a 2% Lidocaine Hydrochloride solution into the anterior chamber. All surgeries were performed by the same surgeon. Subjective pain was measured using a visual analog scale (VAS). Secondary outcomes (BCVA, duration of surgery, endothelial density, rebubbling rate) were recorded during a follow-up period of 3 months. Results: The mean subjective pain of patients in the PBA group was 1.27 (95% CI 0.87–1.68) and 1.64 (95% CI 1.15–2.21) in the TA group. The mean duration of surgery was 402 s (95% CI 356–448) in the PBA group and 427 s (95% CI 371–483) in the TA group, p = 0.477. No major differences were observed in BCVA, endothelium density and rebubbling rate between the two groups. Anaesthesia-related side effects were more frequent in the PAB group than in the TA group. Conclusion: Although levels of subjective pain are lower under PBA than under TA, in selected patients without ocular comorbidities TA can achieve levels of pain acceptable for DMEK surgery.

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“…Previous studies have identified surgically induced iris abnormalities after DMEK, including pupillary shape changes, posterior synechiae formation, and iris depigmentation. 7,8 Arnalich-Montiel et al 9 found that pupillary changes were 5 times more likely in patients who underwent combined cataract and DMEK surgery; 56% of patients demonstrated a spectrum of abnormalities ranging from mild pupil ovalization to midmydriasis with posterior synechiae formation. Two of the patients in this series developed dilated, poorly responsive pupils suggestive of UZS; however, the authors attributed these abnormalities to a nonischemic etiology because the formation of posterior synechiae could be reversed with surgical lysis.…”

Section: Discussionmentioning

confidence: 99%

Case Series of Urrets-Zavalia Syndrome After Descemet Membrane Endothelial Keratoplasty

Bhullar

Venkateswaran²,

Kim³

2020

Cornea

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To present a case series of Urrets-Zavalia syndrome (UZS) that developed after Descemet membrane endothelial keratoplasty (DMEK).Methods: A retrospective chart review was performed to identify patients who underwent DMEK by a single surgeon at the Duke Eye Center from 2017 to 2019 and subsequently developed UZS. Demographic data, preoperative history, operative notes, and postoperative course were reviewed. Results:We describe 5 cases of UZS after DMEK (ages 19-74 years; 3 men and 2 women). Onset of UZS was noted at postoperative week 1 (n = 1), 2 (n =3), or 4 (n = 1). Four patients had an underlying diagnosis of Fuchs endothelial dystrophy and 1 had posterior polymorphous corneal dystrophy. Sixty percent (n = 3) of patients had an elevated intraocular pressure on postoperative day 0 or 1, and 40% (n = 2) of patients also had a pupillary block. One patient developed UZS after a rebubbling procedure for partial graft detachment and another developed UZS after repeat DMEK transplantation. Of the 3 patients who underwent bilateral combined DMEK and cataract surgery, 1 developed UZS in the second eye, whereas 2 developed UZS in the first eye. Most patients experienced monocular diplopia or had cosmetic concerns because of their mydriatic pupils. Two patients had spontaneous improvement in mydriasis.Conclusions: UZS after DMEK is rare, with only 2 cases in the literature: Holtmann et al and Isac et al. We present the largest case series of UZS after DMEK to date. Postoperative elevation in intraocular pressure is a common contributing factor. Evaluation of more patients may elucidate additional risk factors for this condition.

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<p>Surgery-induced iris abnormalities after Descemet membrane endothelial keratoplasty and their impact on postoperative clinical outcomes</p>

Cited by 5 publications

References 18 publications

Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand

Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand

Use of topical anaesthesia and peribulbar anaesthesia in Descemets membrane endothelial keratoplasty

Case Series of Urrets-Zavalia Syndrome After Descemet Membrane Endothelial Keratoplasty

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