'PI-less DMEK': results of Descemet's membrane endothelial keratoplasty (DMEK) without a peripheral iridotomy

Session Details

Session Title: Moderated Poster Session: Cornea

Venue: Poster Village: Pod 1

First Author: : E.Livny ISRAEL

Co Author(s): :    I. Bahar   I. Levy   M. Mimouni   Y. Nahum              

Abstract Details

Purpose:

To assess Descemet's Membrane Endothelial Keratoplasty (DMEK) without performing a peripheral iridotomy (PI) prior to or during surgery ("PI-less DMEK").

Setting:

Ophthalmology department at the Rabin Medical Center, Petach-Tikva, Israel, a tertiary hospital affiliated to Tel-Aviv University,Tel-Aviv, Israel

Methods:

A retrospective cohort study of consecutive patients that underwent DMEK without performing a PI prior to or during surgery ("PI-less DMEK"). SF6 gas completely filled the Anerior chamber at the end of the surgery. In all cases, partial gas evacuation was performed on the slit lamp approx. 90 minutes after surgery by gentle press on a port incision, leaving a free floating gas bubble in the anterior chamber, to avoid pupillary block. Intraoperative and postoperative complications were assessed.

Results:

31 patients were included. Preoperative visual acuity was 1.13±0.59 logMAR. Intraoperative complications included anterior chamber hyphema during graft insertion requiring reinsertion (n=1) and minor hyphema from the main corneal incision (n=1). Partial gas evacuation at the slit lamp was uneventful in all cases. Postoperative complications included graft detachment requiring rebubbling (n=5), uncontrolled intraocular hypertension requiring trabeculectomy (n=1) postoperative cystoid macular edema (n=1) and graft failure 5 months postoperatively (n=1). None developed pupillary block. Cell loss was 49±20%. Excluding graft failure (n=1) & preoperative amblyopia (n=2) ,final visual acuity was 0.24±0.22 logMAR with 30% reaching 6/7.5 (Snellen) or more.

Conclusions:

Performing PI prior to or during DMEK surgery has its risks and limitations, such as iris bleeding, gas escaping to the vitreous through the PI, pigment release etc. This study shows that avoiding PI before or during DMEK surgery is feasible, with satisfactory results. Partial evacuation of the gas from the anterior chamber 90 minutes after surgery is necessary to avoid pupillary block and can be performed safely and easily at the slit lamp.

Financial Disclosure:

None