Outcomes of Descemet membrane endothelial keratoplasty in phakic eyes

PURPOSE: To determine the clinical outcomes of isolated Descemet membrane transplantation (ie, Descemet membrane endothelial keratoplasty [DMEK]) in phakic eyes. SETTING: Tertiary referral center. DESIGN: Cohort study. METHODS: Phakic eyes from a larger group of consecutive eyes that had DMEK for Fuchs endothelial dystrophy were examined. The examination included corrected distance visual acuity (CDVA), subjective and objective refractions, endothelial cell density (ECD), and intraoperative and postoperative complications at 1, 3, and 6 months. RESULTS: The study enrolled 52 phakic eyes from a group of 260 DMEK eyes. Of the phakic eyes, 69% reached a CDVA equal to or better than 20/40 (>= 0.5) within 1 week and 85% reached equal to or better than 20/25 (>= 0.8) at 6 months. Compared with an age-matched control group of pseudophakic eyes, phakic eyes had a similar visual rehabilitation rate, final visual outcome, mean ECD at 6 months (1660 cells/mm(2) +/- 470 [SD]), minor hyperopic shift ( +0.74 diopter), and graft detachment rate (4%). Visual acuity equal to or better than 20/13 (>= 1.5) was limited to phakic eyes, suggesting better optical quality with the crystalline lens in situ. Temporary mechanical angle-closure glaucoma due to air-bubble dislocation behind the iris was the main complication (11.5%). Two eyes (4%) required phacoemulsification after DMEK. CONCLUSIONS: In phakic eyes, DMEK may give excellent visual outcomes without an increased risk for complications. Visual acuities equal to or better than 20/13 (>= 1.5) may indicate that the almost anatomic repair after DMEK is associated with near perfect optical quality of the transplanted cornea.