Descemet membrane endothelial keratoplasty and intraocular lens implantation in cases of aphakic bullous keratopathy

ABSTRACT Purpose: To present the results of a modified sutured transcleral or sutureless intrascleral three-piece foldable intraocular lens (IOL) implantation with Descemet membrane endothelial keratoplasty (DMEK) in cases of aphakic bullous keratopathy (ABK) with inadequate capsular support. Methods: Twenty-one eyes of 21 patients with ABK and inadequate capsular support who underwent DMEK with three-piece foldable IOL implantation from September 2015 to June 2018 were analyzed, retrospectively. Two techniques were used in IOL implantation; sutureless intrascleral fixation of the IOL (ISF-IOL) and sutured transscleral-fixated IOL (TSF-IOL) implantation. Results: Rebubblings due to the graft detachment were needed in 9 (43%) of 21 eyes in the early postoperative period. At the last follow-up visit, 18 (85.7%) of DM grafts were attached. Any complication related to IOL implantation was not observed in the ISF-IOL cases. Exposure of the fixation suture in 1 (25%) of 4 TSF-IOL cases was seen, postoperatively. The increase in the mean best-corrected visual acuity (BCVA) at the last follow-up visit was statistically significant when compared to the mean preoperative BCVA (p < .001). The mean preoperative central corneal thickness was decreased from 883.3 ± 111.8 (700–1150) μm to 582.3 ± 118.2 (490–990) μm at the last follow-up visit (p < .001). Conclusion: DMEK combined with sutureless/sutured three-piece foldable IOL implantation appears to be a feasible method for the management in ABK without adequate capsular support. A faster visual recovery can be obtained with the techniques presented.

[1]  Maria A. Woodward,et al.  Scleral-Fixated Intraocular Lenses , 2017, Journal of vitreoretinal diseases.

[2]  Vipul Bhandari,et al.  Simultaneous Descemet’s membrane endothelial keratoplasty and posterior iris-claw-fixated intra ocular lens implantation (IOL) in management of aphakic bullous keratopathy , 2016, International ophtalmology.

[3]  F. Kruse,et al.  Feasibility and Outcome of Descemet Membrane Endothelial Keratoplasty in Complex Anterior Segment and Vitreous Disease , 2015, Cornea.

[4]  A. Joussen,et al.  Posterior iris-claw aphakic intraocular lens implantation and Descemet membrane endothelial keratoplasty , 2014, British Journal of Ophthalmology.

[5]  T. Röck,et al.  Descemet membrane endothelial keratoplasty in cases with existing scleral-sutured and iris-sutured intraocular lenses , 2014, BMC Ophthalmology.

[6]  Akira Arakawa,et al.  Sutureless 27-gauge needle-guided intrascleral intraocular lens implantation with lamellar scleral dissection. , 2014, Ophthalmology.

[7]  E. G. Groeneveld-van Beek,et al.  Standardized ‘no‐touch’ donor tissue preparation for DALK and DMEK: harvesting undamaged anterior and posterior transplants from the same donor cornea , 2013, Acta ophthalmologica.

[8]  J. Grigg,et al.  Improved refractive outcome for ciliary sulcus-implanted intraocular lenses. , 2012, Ophthalmology.

[9]  S. Prasad,et al.  Needle-guided intrascleral fixation of posterior chamber intraocular lens for aphakia correction. , 2010, Journal of cataract and refractive surgery.

[10]  F. Price,et al.  Descemet's membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival. , 2009, Ophthalmology.

[11]  I. Rodríguez-Agirretxe,et al.  Needle‐guided intrascleral fixation of posterior chamber intraocular lens for aphakia correction , 2009, Journal of cataract and refractive surgery.

[12]  Soosan Jacob,et al.  Fibrin glue–assisted sutureless posterior chamber intraocular lens implantation in eyes with deficient posterior capsules , 2008, Journal of cataract and refractive surgery.

[13]  G. Melles,et al.  Donor tissue preparation for Descemet membrane endothelial keratoplasty , 2008, Journal of cataract and refractive surgery.

[14]  G. Melles,et al.  Preliminary clinical results of Descemet membrane endothelial keratoplasty. , 2008, American journal of ophthalmology.

[15]  G. Melles.  Posterior lamellar keratoplasty: DLEK to DSEK to DMEK. , 2006, Cornea.

[16]  M. Lavin,et al.  Techniques of intraocular lens suspension in the absence of capsular/zonular support. , 2005, Survey of ophthalmology.

[17]  M. Baykara.  Suture burial technique in scleral fixation. , 2004, Journal of cataract and refractive surgery.

[18]  Y. Tsai,et al.  Transscleral fixation of foldable intraocular lens after pars plana lensectomy in eyes with a subluxated lens. , 1999, Journal of cataract and refractive surgery.

[19]  D. Uthoff,et al.  Secondary implantation of scleral‐fixated intraocular lenses , 1998, Journal of cataract and refractive surgery.

[20]  R. D. Stulting,et al.  Penetrating keratoplasty with anterior or posterior chamber intraocular lens implantation. , 1994, Archives of ophthalmology.