Clinical Outcomes of Endothelial Keratoplasty With a Recipient's Entire Descemet Stripping for Iridocorneal Endothelial Syndrome

Purpose

To investigate whether a recipient's entire Descemet stripping reduced endothelial cell loss (ECL) after Descemet membrane endothelial keratoplasty (DMEK) for iridocorneal endothelial (ICE) syndrome.

Design

Randomized controlled clinical trial.

Methods

A total of 48 patients (48 eyes) with ICE syndrome were enrolled between 10 March 2014 and 11 May 11 2022. The eligible patients were divided into the entire recipient's Descemet stripping group (entire stripping group, 24 eyes) or the standard technique group (standard group, 24 eyes). DMEK was performed in all cases with concomitant procedures. The recipient's entire Descemet membrane or the central 8.0- or 8.25-mm diameter of the Descemet membrane was removed intraoperatively. Main outcome measures were ECL, corrected distance visual acuity (CDVA), intraocular pressure (IOP), graft survival, and surgical complications, which were compared 9, 12, and 24 months after surgery.

Results

After a 9-month follow-up, ECL was significantly lower in the entire stripping group than in the standard group. At 2 years postoperatively, the ECL rate was 66% ± 5% and 74% ± 4% (95% CI: −0.04 to 0.01; P = .040), with a cumulative graft success rate of 83% and 67% (95% CI: −0.07 to 0.39; P = .318) in the entire stripping group and the standard group, respectively. The postoperative CDVA level was comparable between the 2 groups throughout the follow-up period. No significant differences between the 2 groups were observed in regard to the incidence of main complications.

Conclusions

Entire recipient's Descemet stripping may delay the pathological progression of ICE syndrome, thereby reducing ECL after DMEK.