Descemet-membrane endothelial keratoplasty in patients with retinal comorbidity -a prospective cohort study

AIM： To investigate indications, surgical challenges, and outcome of Descemet -membrane endothelial keratoplasty （DMEK） in patients with retinal comorbidities （RC）. METHODS： In a prospective cohort study, 8 eyes of 8 DMEK-patients with known RC were compared to 38 eyes of 38 DMEK-patients without RC. The duration of surgery, the degree of difficulty graded by the surgeon, and the complications through DMEK-surgery were analyzed for each patient. The best-corrected visual acuity （BCVA）, the endothelial cell count, the intraocular pressure, and the subjective satisfaction was evaluated after a 6-month follow-up. Data were compared applying the non-parametric Wilcoxon-, Chi-square- and Fisher＇s-exact-test with P≤ 0. 05 as level of significance. RESULTS： RC-patients had dry age-related macular degeneration （n=4） or history of pars-plana vitrectomy （n=4）. The main indication for DMEK was pain due to bullous keratopathy for the RC-patlents （n=7, 88%） and visual impairment due to Fuchs endothelial keratoplasty for the non-RC-patients （n=33, 87% ）. The BCVA increased for both groups （P=0.01, P〈0.001） and all corneas cleared. For the RC-patients, the subjective satisfaction improved significantly （P=0.02）. Oil-filling and missing support of the vitreous body complicated surgery in vitrectomized eyes. CONCLUSION： DMEK is a favorable technique to treat endothelial disorders even if patients suffer from a retinal comorbidity. By enhancing the corneal clarity, it enables retinal examination or intraocular surgery and increases the patients satisfaction. However, in vitrectomized or silicone-oil filled eyes, the duration of surgery and degree of complexity are increased. An experienced surgeon should perform DMEK in these patients. Clinical trial registration number： DRKS00007566.