Long-term clinical outcomes after Descemet Membrane Endothelial Keratoplasty (DMEK) in Irido-Corneal Endothelial Syndrome

PURPOSE: To evaluate the long-term clinical outcomes after Descemet Membrane Endothelial Keratoplasty (DMEK) in Irido-Corneal Endothelial Syndrome (ICE). OBSERVATION: Four eyes of four patients diagnosed with ICE syndrome were treated with DMEK. Postoperatively, best corrected visual acuity (BCVA) and central endothelial cell density (ECD) were documented at 6, 12, 24 and 36 months for all the cases. All procedures were uneventful. Average follow-up time was 36 months. BCVA improved in all eyes. Mean BCVA improved significantly from 1.54 ± 0.71 log MAR preoperatively to 0.11 ± 0.14 logMAR at the final follow-up. Average donor ECD was 2895 ± 357 cells/mm(2) preoperatively and 1992 ± 321 cells/mm(2), 1816 ± 395 cells/mm(2), 1571 ± 299 cells/mm(2) and 1305 ± 246 cells/mm(2) at 6, 12, 24 and 36 months after DMEK surgery respectively. This represented an average endothelial cell loss (ECL) of 31.3%, 37.7%, 46.8% and 55.1% at 6, 12, 24 and 36 months respectively. Postoperative intraocular pressure (IOP) rise was seen in 3 eyes at 1 month which normalized under topical antiglaucoma medications. CONCLUSION: DMEK is a relatively safe procedure providing favourable clinical outcomes in eyes with ICE syndrome. Since angle closure is progressive in these condition, regular IOP monitoring and glaucoma control is critical for long term survival of the graft. IMPORTANCE: Till date management of ICE syndrome has always been a great challenge due to its varied presentation and complex anatomical abnormalities. Replacing the endothelial cells in an irregular anterior chamber poses additional difficulty. Even well-trained DMEK surgeons find it difficult to appose the Descemet's Membrane (DM) in such a scenario and we in this article provide key surgical tips for successful long term management of these cases.