Descemet Membrane Endothelial Keratoplasty in Combination with Pars Plana Vitrectomy in Complex Eyes for Enhanced Gas Tamponades.

Background: DMEK is well-established to treat endothelial corneal diseases. The procedure involves the use of an anterior chamber gastamponade to attach the graft. In eyes after lense extraction, fistulating glaucoma surgery or with large iris defects the gas tamponade is often lost postoperatively in the vitreous cavity or subconjunctival. We are reporting on three cases below, in which simultaneous anterior and posterior chamber gas tamponade were inserted with a combination of DMEK and 23-G pars plana vitrectomy (ppV).
Case Descriptions: In the first case, a 70-year-old man experienced complete gas dislocation into the vitreous cavity early on after DMEK, resulting in re-bubbling being carried out in combination with 23-G ppV. In the second case, DMEK was immediately combined with ppV for an 80-year-old man who had an Ahmed glaucoma implant, and for a 61-year-old woman, our third case, who had traumatic aphakia. In all three cases, the vitreous cavity and anterior chamber were filled with 20% SF 6 as much as possible. In the second case, it was necessary to perform a re-bubbling due to partial graft dehiscence that occurred on the fifth day post-DMEK. The intraocular pressure in all three cases remained compensated postoperatively, and visual acuity increased despite the complex pre-existing conditions that had limited vision prior.
Discussion: The combined endotamponade of the anterior and posterior chambers while performing DMEK with 23-G ppV can extend the gas endotamponade in patients whose eyes have a complex medical history, and can thus ensure successful graft adherence.
Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht./The authors declare that they have no conflict of interest.
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