Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Safety and clinical outcomes of omitting same and next day review after DMEK performed with an inferior peripheral iridotomy

Eye volume 37, pages 3492–3495 (2023)Cite this article

Subjects

Abstract

Background/objectives

To determine the incidence of day one postoperative complications after Descemet Membrane Endothelial Keratoplasty (DMEK) performed with intraoperative inferior peripheral iridotomy (PI), and whether their early detection influences postoperative intervention.

Subjects/methods

70 eyes of 70 consecutive patients that underwent DMEK from August 2019 to August 2021 at a single UK centre were retrospectively analysed. Cases that did not have an inferior PI were excluded. Any action taken at day one and week one postoperative review was noted.

Results

No pupil block or other major adverse events were found at day one review. At one week, 14 eyes (20%) required re-bubbling, all of which had been fully attached at the day one review.

Conclusions:

This series suggests that inferior PI performed alongside DMEK alone or triple DMEK effectively minimizes the risk of pupil block. Since no early complications occurred in this cohort requiring immediate intervention, it may be safe to defer review of these patients to a later time point.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Data availability

Data collected for the study are not openly available due to reasons of sensitivity but are available from the corresponding author upon reasonable request.

References

  1. Guerra FP, Anshu A, Price MO, Price FW. Endothelial keratoplasty: fellow eyes comparison of descemet stripping automated endothelial keratoplasty and descemet membrane endothelial keratoplasty. Cornea . 2011;30:1382–6.

    Article  PubMed  Google Scholar 

  2. Tourtas T, Laaser K, Bachmann BO, Cursiefen C, Kruse FE. Descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2012;153:1082–90.e2.

    Article  PubMed  Google Scholar 

  3. Hamzaoglu EC, Straiko MD, Mayko ZM, Sáles CS, Terry MA. The first 100 eyes of standardized descemet stripping automated endothelial keratoplasty versus standardized descemet membrane endothelial keratoplasty. Ophthalmology. 2015;122:2193–9.

    Article  PubMed  Google Scholar 

  4. Rapoport Y, Veldman P. A comprehensive review of postoperative management of descemet’s membrane endothelial keratoplasty. Semin Ophthalmol. 2017;32:104–10.

    Article  PubMed  Google Scholar 

  5. Güell JL, Morral M, Gris O, Elies D, Manero F. Comparison of sulfur hexafluoride 20% versus air tamponade in descemet membrane endothelial keratoplasty. Ophthalmology . 2015;122:1757–64.

    Article  PubMed  Google Scholar 

  6. Studeny P, Sivekova D, Liehneova K, Vokrojova M, Kuchynka P. Hybrid technique of lamellar keratoplasty (DMEK-S). J Ophthalmol. 2013; 2013. Available at: /pmc/articles/PMC3687501/. [Accessed August 31, 2021].

  7. Terry MA, Straiko MD, Veldman PB, Talajic JC, Vanzyl C, Sales CS, et al. Standardized DMEK technique: reducing complications using prestripped tissue, novel glass injector, and sulfur hexafluoride (SF 6) gas. Cornea .2015;34:845–52.

    Article  PubMed  Google Scholar 

  8. Maier AKB, Pilger D, Gundlach E, Winterhalter S, Torun N. Long-term results of intraocular pressure elevation and post-DMEK glaucoma after descemet membrane endothelial keratoplasty. Cornea . 2021;40:26–32.

    Article  PubMed  Google Scholar 

  9. Fogla R, Thazethaeveetil IR. A novel technique for donor insertion and unfolding in descemet membrane endothelial keratoplasty. Cornea.2021;40:1073–8.

    Article  PubMed  Google Scholar 

  10. Maier A-KB, Wolf T, Gundlach E, Klamann MKJ, Gonnermann J, Bertelmann E, et al. Intraocular pressure elevation and post-DMEK glaucoma following Descemet membrane endothelial keratoplasty. Graefe’s Arch Clin Exp Ophthalmol 2014. 2014;252:1947–54.

    Article  Google Scholar 

  11. Livny E, Bahar I, Levy I, Mimouni M, Nahum Y. “PI-less DMEK”: results of Descemet’s membrane endothelial keratoplasty (DMEK) without a peripheral iridotomy. Eye. 2018;33:653–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Stanzel TP, Ersoy L, Sansanayudh W, Felsch M, Dietlein T, Bachmann B, et al. Immediate postoperative intraocular pressure changes after anterior chamber air fill in descemet membrane endothelial keratoplasty. Cornea . 2016;35:14–9.

    Article  PubMed  Google Scholar 

  13. Schaub F, Enders P, Snijders K, Schrittenlocher S, Siebelmann S, Heindl LM, et al. One-year outcome after Descemet membrane endothelial keratoplasty (DMEK) comparing sulfur hexafluoride (SF6) 20% versus 100% air for anterior chamber tamponade. Br J Ophthalmol 2017;101:902–8. https://bjo.bmj.com/content/101/7/902.

    Article  Google Scholar 

  14. Gonzalez A, Price FW, Price MO, Feng MT. Prevention and management of pupil block after descemet membrane endothelial keratoplasty. Cornea .2016;35:1391–5.

    Article  PubMed  Google Scholar 

  15. Röck D, Bartz-Schmidt KU, Röck T, Yoeruek E. Air bubble-induced high intraocular pressure after descemet membrane endothelial keratoplasty. Cornea. 2016;35:1035–9.

    Article  PubMed  Google Scholar 

  16. Roberts HW, Kit V, Phylactou M, Din N, Wilkins MR. ‘Posture-Less’ DMEK: is posturing after descemet membrane endothelial keratoplasty actually necessary? Am J Ophthalmol. 2022;240:23–9. https://doi.org/10.1016/j.ajo.2022.02.009

    Article  PubMed  Google Scholar 

  17. Crews JW, Price MO, Lautert J, Feng MT, Price FW. Intraoperative hyphema in descemet membrane endothelial keratoplasty alone or combined with phacoemulsification. J Cataract Refract Surg. 2018;44:198–201.

    Article  PubMed  Google Scholar 

  18. Arnalich-Montiel F, Pérez-Sarriegui A, Lauzirika G, Porrua L, Hernández-Verdejo JL. Pupillary abnormalities in descemet membrane endothelial keratoplasty after nearly full tamponade. Cornea .2017;36:290–4. https://journals.lww.com/corneajrnl/Fulltext/2017/03000/Pupillary_Abnormalities_in_Descemet_Membrane.6.aspx.

    Article  PubMed  Google Scholar 

  19. Marques RE, Guerra PS, Sousa DC, Ferreira NP, Gonçalves AI, Quintas AM, et al. Sulfur hexafluoride 20% versus Air 100% for anterior chamber tamponade in dmek: a meta-analysis. Cornea .2018;37:691–7. https://journals.lww.com/corneajrnl/Fulltext/2017/03000/Pupillary_Abnormalities_in_Descemet_Membrane.6.aspx.

    Article  PubMed  Google Scholar 

  20. Leon P, Parekh M, Nahum Y, Mimouni M, Giannaccare G, Sapigni L, et al. Factors associated with early graft detachment in primary descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2018;187:117–24. https://doi.org/10.1016/j.ajo.2017.12.01

    Article  PubMed  Google Scholar 

  21. Guindolet D, Disegni H, Martin GC, Azar G, Hardy S, Cochereau I, et al. Predictive factors of graft detachment and rebubbling after descemet membrane endothelial keratoplasty. Int Ophthalmol. 2022. https://doi.org/10.1007/s10792-022-02547-4.

    Article  PubMed  Google Scholar 

  22. Tan JHY, Newman DK, Klunker C, Watts SE, Burton RL. Phacoemulsification cataract surgery: is routine review necessary on the first post-operative day? Eye. 2000;14:53–5. https://www.nature.com/articles/eye200011.

    Article  PubMed  Google Scholar 

  23. Anon. 2019 Outpatients project – Results published — NHS Benchmarking Network. Available at: https://www.nhsbenchmarking.nhs.uk/news/2019-outpatients-project-results-published. [Accessed August 31, 2021].

Download references

Funding

HR has undertaken paid consultancy work for Alcon Inc (Fort Worth, TX, USA) in the past 12 months and has received honoraria from Thea Pharmaceuticals Ltd (Keele, UK).

Author information

Authors and Affiliations

  1. Eye Department, Southend University Hospital, Southend-on-Sea, SS0 0RY, UK

    Harry W. Roberts, Haseeb Akram, Max Davidson & James Myerscough

  2. West of England Eye Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK

    Harry W. Roberts

  3. University of Exeter Medical School, University of Exeter, Exeter, UK

    Harry W. Roberts

  4. Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK

    James Myerscough

Authors
  1. Harry W. Roberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haseeb Akram
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Max Davidson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James Myerscough
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HA collected data and wrote the first draft. MD and HR contributed heavy editing. JM was supervising author.

Corresponding author

Correspondence to Harry W. Roberts.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roberts, H.W., Akram, H., Davidson, M. et al. Safety and clinical outcomes of omitting same and next day review after DMEK performed with an inferior peripheral iridotomy. Eye 37, 3492–3495 (2023). https://doi.org/10.1038/s41433-023-02542-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41433-023-02542-8

Search

Advanced search

Quick links