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. 2021 Sep;259(9):2731-2741.
doi: 10.1007/s00417-021-05203-2. Epub 2021 May 11.

Effects of uncomplicated Descemet membrane endothelial keratoplasty on the central retinal thickness

Tibor Lohmann  1 , Sabine Baumgarten  1 , Niklas Plange  1 , Peter Walter  1 , Matthias Fuest  2
Affiliations

Effects of uncomplicated Descemet membrane endothelial keratoplasty on the central retinal thickness

Tibor Lohmann et al. Graefes Arch Clin Exp Ophthalmol. 2021 Sep.

Abstract

Purpose: To determine retinal thickness (RT) changes and the incidence of macular edema after uncomplicated Descemet membrane endothelial keratoplasty (DMEK-ME) in patients without ME risk factors.

Methods: In this retrospective study, 107 pseudophakic eyes of 74 patients with Fuchs endothelial dystrophy (FED) (79.4%) or bullous keratopathy (BK) (20.6%) underwent DMEK surgery between 2016 and 2019 at the Department of Ophthalmology, RWTH Aachen University. Patients with intra- or postoperative complications as well as pre-existing risk factors for ME were excluded. Macular spectral-domain optical coherence tomography (SD-OCT) and best spectacle-corrected visual acuity (BSCVA) measurements were performed before, 1 week, 1 month, and 6 months after surgery. Retinal thickness (RT) was analyzed in the central foveal 1 mm (CSF), parafoveal 3 mm and 6 mm subfield.

Results: Eight eyes (7.5%) developed DMEK-ME 1 month after surgery. Six DMEK-ME eyes (75%) were rebubbled, compared with 31.3% (31 of 99; P = 0.02) of the non DMEK-ME eyes. DMEK-ME eyes had a significantly thicker CSF 1 month after surgery (432.0 ± 97.6 μm) compared with non-DMEK-ME eyes (283.7 ± 22.2 μm; P = 0.01). The other subfields and time points showed no significant RT changes. DMEK-ME significantly impaired BSCVA (0.38 ± 0.92 logMAR) only 1 month after surgery in comparison to the non DMEK-ME eyes (0.23 ± 0.87 logMAR, P = 0.015).

Conclusion: Excluding systemic and surgery-related risk factors, rebubbling increases the risk of DMEK-ME. Performing a CSF scan 1 month after surgery, particularly in rebubbled eyes, efficiently detects DMEK-ME and allows the prompt initiation of treatment, e.g., topical corticosteroid and non-steroidal (NSAID) eye drops.

Keywords: Descemet membrane endothelial keratoplasty; Lamellar corneal surgery; Macular edema; Retinal thickness.

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Conflict of interest statement

The authors report no conflicts of interest.

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
Retinal thickness (RT) map in the HRA/Spectralis Viewing Module (Heidelberg Eye Explorer, Heidelberg Engineering, Heidelberg, Germany) and spectral-domain optical coherence tomography (SD-OCT) imaging prior to uncomplicated Descemet membrane endothelial keratoplasty (DMEK) surgery and 1 month after the surgery with the presentation of macular edema (DMEK-ME). A RT map prior to DMEK surgery. B En-face infrared imaging and SD-OCT imaging of the retina prior to DMEK surgery. C RT map one month after DMEK surgery with DMEK-ME. D En-face infrared imaging and SD-OCT imaging of the retina one month after DMEK surgery. The arrow points at the cystoid macular edema. □ = central subfield (CSF), corresponding to the 1 mm Early Treatment Diabetic Retinopathy Study (EDTRS) subfield. † = 3 mm ETDRS subfield. * = 6 mm ETDRS subfield
Fig. 2
Fig. 2
Central subfield (CSF) in μm in uncomplicated Descemet membrane endothelial keratoplasty surgery with and without macular edema at various time points. CSF = central subfield, corresponding to the retinal thickness in the 1 mm subfield of the Early Treatment Diabetic Retinopathy Study (EDTRS) in the retinal thickness map of the HRA/Spectralis Viewing Module (Heidelberg Eye Explorer, Heidelberg Engineering, Heidelberg, Germany). DMEK = Descemet membrane endothelial keratoplasty; DMEK-ME = macular edema after uncomplicated DMEK surgery. * = the CSF in DMEK-ME eyes was significantly thicker one month after surgery compared to pre-surgery and compared to the CSF in non DMEK-ME eyes one month after surgery; P < 0.05
Fig. 3
Fig. 3
Retinal thickness in μm in uncomplicated Descemet membrane endothelial keratoplasty surgeries developing macular edema (DMEK-ME) in the 1 mm, 3 mm and 6 mm subfield at various time points. CSF = central subfield, corresponding to the retinal thickness in the 1 mm subfield of the Early Treatment Diabetic Retinopathy Study (EDTRS) in the retinal thickness map of the HRA/Spectralis Viewing Module (Heidelberg Eye Explorer, Heidelberg Engineering, Heidelberg, Germany).; 3 mm subfield = 3 mm ETDRS subfield; 6 mm subfield = 6 mm ETDRS subfield. * = the CSF was significantly thicker one month after surgery compared to pre-surgery; P < 0.05
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