Descemet Membrane Endothelial Keratoplasty in Combination with Pars Plana Vitrectomy in Complex Eyes for Enhanced Gas Tamponades

Abstract

Background DMEK is well-established to treat endothelial corneal diseases. The procedure involves the use of an anterior chamber gastamponade to attach the graft. In eyes after lense extraction, fistulating glaucoma surgery or with large iris defects the gas tamponade is often lost postoperatively in the vitreous cavity or subconjunctival. We are reporting on three cases below, in which simultaneous anterior and posterior chamber gas tamponade were inserted with a combination of DMEK and 23-G pars plana vitrectomy (ppV).

Case Descriptions In the first case, a 70-year-old man experienced complete gas dislocation into the vitreous cavity early on after DMEK, resulting in re-bubbling being carried out in combination with 23-G ppV. In the second case, DMEK was immediately combined with ppV for an 80-year-old man who had an Ahmed glaucoma implant, and for a 61-year-old woman, our third case, who had traumatic aphakia. In all three cases, the vitreous cavity and anterior chamber were filled with 20% SF 6 as much as possible. In the second case, it was necessary to perform a re-bubbling due to partial graft dehiscence that occurred on the fifth day post-DMEK. The intraocular pressure in all three cases remained compensated postoperatively, and visual acuity increased despite the complex pre-existing conditions that had limited vision prior.

Discussion The combined endotamponade of the anterior and posterior chambers while performing DMEK with 23-G ppV can extend the gas endotamponade in patients whose eyes have a complex medical history, and can thus ensure successful graft adherence.

Key words

cornea - vitreous body - DMEK - ppV - complex eyes - gas tamponade

Publication History

Received: 13 March 2022

Accepted: 16 September 2022

Accepted Manuscript online:
26 September 2022

Article published online:
29 March 2023

• References/Literatur

• 1 Melles GR, Eggink FA, Lander F. et al. A surgical technique for posterior lamellar keratoplasty. Cornea 1998; 17: 618-626
• 2 Geerling G, Duncker GI, Krumeich J. et al. Lamelläre Keratoplastik. Zurück in die Zukunft?!. Ophthalmologe 2005; 102: 1140-1148 1150–1151
• 3 Melles GR. Posterior lamellar keratoplasty: DLEK to DSEK to DMEK. Cornea 2006; 25: 879-881
• 4 Anshu A, Price MO, Price jr. FW. Risk of corneal transplant rejection significantly reduced with Descemetʼs membrane endothelial keratoplasty. Ophthalmology 2012; 119: 536-540
• 5 Spaniol K, Borrelli M, Holtmann C. et al. Komplikationen der Descemetmembran-Endothel-Keratoplastik. Ophthalmologe 2015; 112: 974-981
• 6 Bachmann B, Matthaei M, Schrittenlocher S. et al. “Descemet membrane endothelial keratoplasty” in komplexen Augen. Ophthalmologe 2019; 116: 228-235
• 7 Fili S, Perdikakis G, Vastardis I. et al. DMEK bei komplizierten Fällen einer bullösen Keratopathie nach multiplen Augenoperationen. Ophthalmologe 2021; 118: 926-932
• 8 Goshe JM, Li JY, Terry MA. et al. Graft dislocation and hypotony after Descemetʼs stripping automated endothelial keratoplasty in patients with previous glaucoma surgery. Ophthalmology 2012; 119: 1130-1133
• 9 Steindor FA, Menzel-Severing J, Geerling G. et al. Wound Healing of Descemet Membrane After Penetrating Keratoplasty and Its Relevance for Descemet Membrane Endothelial Keratoplasty Surgeons. Cornea 2021; 40: 910-913
• 10 Heindl LM, Koch KR, Bucher F. et al. Descemet membrane endothelial keratoplasty in eyes with glaucoma implants. Optom Vis Sci 2013; 90: e241-e244
• 11 Yoeruek E, Rubino G, Bayyoud T. et al. Descemet membrane endothelial keratoplasty in vitrectomized eyes: clinical results. Cornea 2015; 34: 1-5