Enhancing Descemet Membrane Endothelial Keratoplasty in Postvitrectomy Eyes With the Use of Pars Plana Infusion.
OBJECTIVE
To present a modified surgical technique to perform Descemet membrane endothelial keratoplasty (DMEK) in previously vitrectomized eyes and to analyze its safety and efficacy.


METHODS
A retrospective analysis of previously vitrectomized eyes that underwent DMEK at Toronto Western Hospital was performed. The modified DMEK technique that was used included placement of a posterior pars plana infusion to reduce fluctuations in the anterior chamber depth and its excessive deepening.


RESULTS
Twelve eyes of 12 patients (5 females and 7 males) aged 65.3 ± 21.5 years were included. Mean best-corrected visual acuity improved significantly from 1.72 ± 0.62 logMAR (mean Snellen ∼20/1040) preoperatively to 1.01 ± 0.64 logMAR (mean Snellen ∼20/200) at 6 months postoperatively (P = 0.017). Mean donor endothelial cell density was 2658 ± 229 cells/mm preoperatively and 1732 ± 454 cells/mm at 6 months after the procedure (mean percentage cell loss of 31.8%) (P = 0.046). There were no significant intraoperative complications, and no graft failures. One eye had graft detachment, which resolved after 2 rebubbling procedures. One eye had retinal detachment, which was corrected surgically.


CONCLUSIONS
The use of posterior pars plana infusion in previously vitrectomized eyes stabilizes the anterior segment during DMEK, allowing for performance of DMEK surgery, and can potentially reduce intraoperative and postoperative complications.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
Nir
N
Sorkin
Adi
A
Einan-Lifshitz
Zach
Z
Ashkenazy
Tanguy
T
Boutin
Mahmood
M
Showail
Armand
A
Borovik
Murad
M
Alobthani
Clara C
CC
Chan
David S
DS
Rootman
D000085:Acetates / Q000008:administration & dosage*; D000368:Aged; D000867:Anterior Chamber / Q000187:drug effects*; D060437:Artificial Lens Implant Migration / Q000601:surgery; D002452:Cell Count; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D055954:Corneal Endothelial Cell Loss / Q000503:physiopathology; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004338:Drug Combinations; D004728:Endothelium, Corneal / Q000473:pathology; D015807:Eye Injuries, Penetrating / Q000601:surgery; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007263:Infusions, Parenteral; D007431:Intraoperative Complications; D008297:Male; D008903:Minerals / Q000008:administration & dosage*; D012163:Retinal Detachment / Q000601:surgery; D012189:Retrospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*; D016683:Supine Position; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
D000085:Acetates; C030660:BSS solution; D004338:Drug Combinations; D008903:Minerals; D012965:Sodium Chloride