Outcomes of DMEK without peripheral iridotomy and a review of the literature

Purpose: To enlist the results of Descemet membrane endothelial keratoplasty (DMEK) without peripheral iridotomy (PI) and to analyze the risks and benefits associated with this approach. Methods: Medical records of 57 patients who underwent DMEK without PI between January 2019 and March 2023 were retrospectively reviewed. The primary outcome was the incidence of pupillary block (PB), and the secondary outcomes were graft detachment, rebubbling rates, and best-corrected logMAR distance visual acuity (BCDVA) at 6 months. Results: The median age (interquartile range (IQR)) of the participants was 66 years (range: 61–73 years). The median (IQR) BCDVA 6 months post-DMEK was 0.18 (IQR: 0.1–0.3); 82% of eyes achieved a BCDVA of >20/40. PB due to air bubble migration into the posterior chamber, resulting in appositional angle closure, was seen in 2/57 (3.5%) cases. Conclusion: DMEK without PI gives comparable long-term results regarding visual acuity and graft survival. Despite the predisposition of Caucasian eyes to angle-closure glaucoma, the incidence of PB was comparable to eyes undergoing DMEK with PI. Therefore, avoiding this step can save surgical time and prevent PI-related complications.