title: Feasibility and Outcome of Descemet Membrane Endothelial Keratoplasty in Complex Anterior Segment and Vitreous Disease.
abstract: OBJECTIVE
  Descemet membrane endothelial keratoplasty (DMEK) is becoming the method of choice for treating Fuchs endothelial dystrophy and pseudophakic bullous keratopathy. We investigated whether DMEK can serve as a routine procedure in endothelial decompensation even in complex preoperative situations.
  
  
  METHODS
  Of a total of 1184 DMEK surgeries, 24 consecutive eyes with endothelial decompensation and complex preoperative situations were retrospectively analyzed and divided into 5 groups: group 1: irido-corneo-endothelial syndrome (n = 3), group 2: aphakia, subluxated posterior chamber intraocular lens or anterior chamber intraocular lens (n = 6), group 3: DMEK after trabeculectomy (n = 4), group 4: DMEK with simultaneous intravitreal injection (n = 6), and group 5: DMEK after vitrectomy (n = 5). Main outcome parameters were best-corrected visual acuity, central corneal thickness, endothelial cell density, rebubbling rate, and graft failure rate.
  
  
  RESULTS
  Best-corrected visual acuity (logMAR) increased from 0.98 to 0.53 (P = 0.002), 0.53 (P = 0.091), and 0.57 (P = 0.203) after 1, 3, and 6 months, respectively. Central corneal thickness decreased from 731 ± 170 to 546 ± 152 μm (P = 0.001), 514 ± 66 μm (P = 0.932), and 554 ± 98 μm (P = 0.004) after 1, 3, and 6 months, respectively. Donor endothelial cell density decreased from 2478 ± 185 to 1454 ± 193/mm² (P < 0.001), 1301 ± 298/mm² (P = 0.241), and 1374 ± 261/mm² (P = 0.213), after 1, 3, and 6 months, respectively. The rebubbling rate was 46% (11/24). Four patients (17%) had secondary graft failure.
  
  
  CONCLUSIONS
  Our data provide evidence that DMEK is feasible for the treatment of endothelial decompensation in complex preoperative situations.
authors.affiliation: Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Weller
authors.forename: Theofilos
authors.initials: T
authors.lastname: Tourtas
authors.forename: Friedrich E
authors.initials: FE
authors.lastname: Kruse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000869:Anterior Eye Segment / Q000473:pathology*; D015715:Corneal Edema / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005128:Eye Diseases / Q000150:complications*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body / Q000473:pathology*