Purpose: Descemet membrane endothelial keratoplasty (DMEK) is the preferred treatment for corneal endothelial dysfunction; nonetheless, its feasibility and outcomes in vitrectomized eyes remain uncertain. We evaluated the outcomes and surgical considerations of endothelium-in pull-through DMEK in vitrectomized eyes with bullous keratopathy. Methods: Eight vitrectomized eyes from eight patients (mean age, 71.9 ± 15.4 years; mean follow-up, 4.9 ± 1.6 months) underwent endothelium-in pull-through DMEK using the EndoGlide between August 2023 and October 2024. Best spectacle-corrected visual acuity, endothelial cell density, central corneal thickness, and complications were recorded. Results: In 5 eyes (62.5%), the graft unfolded smoothly; in 3 eyes (37.5%), excessive unfolding required conversion to an endothelium-out roll using the double-bubble technique. All grafts attached without rebubbling. The best spectacle-corrected visual acuity improved from 1.00 logMAR (interquartile range, 0.65–1.10) preoperatively to 0.30 (0.13–0.55) and 0.40 (0.15–0.52) logMAR at 3 and 6 months, respectively (Wilcoxon, both P < 0.05). The central corneal thickness decreased from 693.5 µm (640–788.8) to 522.5 µm (502.3–564.3) and 549 µm (542–577) at 3 and 6 months, respectively (Wilcoxon, both P < 0.05). The endothelial cell density decreased from 2737 cells/mm 2 (2540–2928) preoperatively to 2412 cells/mm 2 (2284–2610) and 2238 cells/mm 2 (2086–2245) at 3 and 6 months, respectively; at the final follow-up, the median cell density was 2288 cells/mm 2 (2200–2428), representing a 16.4% loss relative to the donor value. Conclusions: Endothelium-in pull-through DMEK is feasible in vitrectomized eyes, achieving stable attachment with visual and anatomical improvement even when adjunctive maneuvers are required, demonstrating clinical utility in postvitrectomy corneal edema.
Fujiwara et al. (Thu,) studied this question.