RESUMEN
PURPOSE: To investigate the efficacy and safety of Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following primary Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: This was a retrospective case series of 15 patients that underwent DMEK surgery for corneal decompensation after failed DSAEK. Main outcome parameter was corrected distance visual acuity (CDVA) after DMEK and DSAEK. Secondary outcome measures included central corneal thickness (CCT), endothelial cell density (ECD), rebubbling rate, and primary graft failure after DMEK. Explanted DSAEK grafts were evaluated by light microscopy. RESULTS: The mean (±SD) time period between DSAEK and DMEK surgery was 15±8 months (range, 6-31 months). Preoperative CDVA was 1.72±0.62 (logMAR). After DMEK, CDVA improved significantly to 0.78±0.48 at 1 month and to 0.23±0.24 after 12 months (P=0.022). Visual acuity data after DMEK were significantly better compared to preoperative values. The average CCT after DMEK decreased significantly from 869±210 µm (preoperative) to 505±45 µm (1 month postoperative) (P<0.001) and remained stable over 12 months. The ECD decreased from 2,589±209/mm2 (preoperative) to 1,691±589/mm2 (12 months postoperative). Rebubbling DMEK was required in three patients (=20%). CONCLUSION: DMEK represents a feasible and safe procedure in achieving better functional results compared to DSAEK. Visual acuity and optical quality can be effectively reestablished after unsuccessful primary DSAEK surgery even in patients with long-standing corneal decompensation. Further investigations are required to validate the preliminary clinical findings.
RESUMEN
PURPOSE: To evaluate if repeat Descemet membrane endothelial keratoplasty (DMEK) is appropriate to achieve functional improvements in patients with corneal decompensation from secondary graft failure after primary DMEK. METHODS: This is a retrospective monocentric cohort study including 13 eyes of 13 patients with repeat DMEK for corneal decompensation following primary DMEK. Eyes with primary DMEK only and comparable preoperative corrected distance visual acuity (CDVA) served as control. Main outcome parameter was CDVA. Secondary outcome measures were central corneal thickness (CCT), endothelial cell density, and rebubbling rate (RR). RESULTS: The average time interval (±SD) between primary and secondary DMEK was 12.5±6 months. Preoperative CDVA (logMAR) was 1.97±0.90 in the repeat DMEK group and 1.38±0.92 in the primary DMEK group. At 6 months, both groups showed significant improvement in visual acuity (repeat DMEK group, 0.49±0.35, P<0.01 and primary DMEK group, 0.40±0.36, P<0.01). CDVA did not differ significantly between both groups at all time points examined (1, 3, and 6 months postoperatively). Mean CCT values at 3 and 6 months postoperatively did not differ significantly between the two groups (P>0.05). The RR was 23% (n=3) in both groups. CONCLUSION: Repeat DMEK is a useful therapeutic approach in the setting of corneal decompensation following primary DMEK. Functional results of repeat DMEK, visual acuity in particular, are comparable to patients with single DMEK only.
RESUMEN
PURPOSE: To report visual and refractive outcomes after implantation of a trifocal intraocular lens (IOL) in highly myopic patients. SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Retrospective case series. METHODS: This study included eyes with previous phacoemulsification and implantation of a trifocal IOL (AT LISA tri 839MP or 939MP) with an IOL power between 0.0 diopter (D) and 10.0 D. Postoperative outcomes at 3 months including uncorrected distance (UDVA), intermediate (UIVA), and near visual acuity (UNVA), corrected distance visual acuity, spherical equivalent, and refractive astigmatism were analyzed. Age-matched eyes after implantation of the same trifocal IOL with higher dioptric power (>10.0 D) served as controls. RESULTS: Thirty-six eyes of 19 patients were included: 18 eyes (10 patients) in the highly myopic group (IOL power 0.0 to 10.0 D) and 18 eyes (9 patients) in the age-matched control group (IOL power >10.0 D). Three months postoperatively, the mean UDVA, UIVA, and UNVA in the highly myopic group were 0.06 logarithm of the minimum angle of resolution (logMAR) ± 0.08 (SD), 0.13 ± 0.09 logMAR, and 0.12 ± 0.07 logMAR, and -0.01 ± 0.10 logMAR, 0.04 ± 0.10 logMAR, and 0.04 ± 0.11 logMAR in the control group, respectively (P = .022, P = .033, P = .053, respectively). CONCLUSION: Implantation of a trifocal IOL in highly myopic eyes with low IOL power (0.0 to 10.0 D) provided satisfactory short-term visual and refractive outcomes; however, results were not as good as those obtained in eyes with higher dioptric IOL power.
