Descemet Membrane Endothelial Keratoplasty Combined With Epithelial Debridement and Mitomycin-C Application for Fuchs Dystrophy With Preoperative Subepithelial Fibrosis or Anterior Basement Membrane Dystrophy

PURPOSE: The aim of this study was to evaluate the anterior corneal surface regularity and light scattering before and after Descemet membrane endothelial keratoplasty (DMEK) with epithelial debridement and application of mitomycin C in Fuchs dystrophy-affected eyes with preoperative subepithelial fibrosis or anterior basement membrane dystrophy. METHODS: In this case-control study, a chart review identified 37 eyes with Fuchs dystrophy and anterior corneal changes evident on preoperative slit lamp examination and that underwent DMEK combined with epithelial removal plus mitomycin-C application. These cases were compared with 83 contemporaneous DMEK procedures performed in eyes with Fuchs dystrophy without clinically evident anterior surface problems (controls). The outcome measures were corrected distance visual acuity (CDVA), corneal surface regularity assessed by topography, anterior corneal light scattering by densitometry, endothelial cell loss, and complications. RESULTS: Cases and controls had comparable demographics. Preoperatively, the cases had significantly poorer corneal surface regularity and transparency than did controls (P < 0.0001). Six months postoperatively, the cases achieved comparable CDVA, corneal surface regularity, and transparency as did controls (all P > 0.05), and 77% had a CDVA ≥ 20/25, excluding 2 eyes with preexisting retinal problems. The median 6-month endothelial cell loss was 25% and did not differ significantly between cases and controls (P = 0.31). In 1 case, there was delayed epithelial healing. CONCLUSIONS: Even patients with endothelial dysfunction with anterior stromal changes can realize a significant improvement in corneal surface topography and transparency by undergoing combined epithelial removal with DMEK, and this can preclude the need for a subsequent procedure to address residual corneal surface problems or the need for a penetrating keratoplasty.