Descemet membrane endothelial keratoplasty in iridocorneal endothelial syndrome and posterior polymorphous corneal dystrophy

Objective: To report the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) in cases of corneal decompensation secondary to iridocorneal endothelial syndrome (ICE) or posterior polymorphous corneal dystrophy (PPCD).

Design: Retrospective interventional case series.

Participants: Eight eyes of 7 patients that underwent DMEK due to corneal decompensation secondary to either ICE syndrome or PPCD, and had at least 6 months of postoperative follow-up.

Methods: Data were collected on best corrected visual acuity (BCVA), graft attachment and survival, endothelial cell density (ECD), and intraocular pressure (IOP). BCVA change, ECD loss, and IOP elevations were analyzed.

Results: Patients' age was 51.5 ± 13.3years. Four eyes (4 patients) had ICE syndrome and 4 eyes (3 patients) had PPCD. All procedures were uneventful. Follow-up time was 11.3 ± 7.6 months (range 6-24 months). DMEK was combined with goniosynechiolysis in 3 eyes and iridoplasty in 1 eye. BCVA improved in all eyes. Mean BCVA improved from 0.70 ± 0.34 logMAR (Snellen equivalent ∼20/100; range 20/50-20/400) preoperatively to 0.21 ± 0.14 logMAR (Snellen equivalent ∼20/34; range 20/20-20/40) at the final follow-up (p = 0.008). Donor ECD was 2740 ± 193 cells/mm² preoperatively and 1967 ± 277 cells/mm² at 6 months after surgery (p = 0.010)-cell loss rate of 27.8%. There were no graft rejections and no graft failures. Postoperative IOP rise (steroid response) was seen in 2 eyes, and was managed successfully with topical medical treatment. There was no evidence of glaucoma progression in any of the cases.

Conclusions: DMEK surgery was effective in treating corneal decompensation secondary to ICE syndrome and PPCD. Adjunct procedures can be simultaneously combined with DMEK to address other disease aspects.