Purpose:To assess Descemet’s membrane endothelial keratoplasty (DMEK) without performing a peripheral iridotomy (PI) prior to or during surgery (“PI-less DMEK”).Materials and methods:This retrospective study included consecutive patients that underwent PI-less DMEK by a single surgeon (E.L) between February 2016 and February 2017 at the Rabin Medical Center, a Tertiary Hospital. Intraoperative and postoperative complications were assessed.Results:Thirty-one patients, mean age 75.9 ± 7.9 years with 58.1% female were included. Leading indications for surgery were pseudophakic bullous keratopathy (18/31) and Fuchs’ endothelial dystrophy (9/31). Preoperative best-corrected distance visual acuity was 1.13 ± 0.59 logMAR (~6/80 Snellen). For 12/31 that had postoperative endothelial cell count measurements, cell loss was 49 ± 20%. Intraoperative complications included anterior chamber (AC) hyphema during graft insertion requiring reinsertion (n = 1), and minor hyphema from the main corneal incision (n = 1). Partial slit lamp gas evacuation was performed in all patients 1.5 h postoperatively. Postoperative complications included partial graft detachment requiring rebubbling (n = 5), self-resolving minimal peripheral graft detachment (n = 5), uncontrolled intraocular hypertension requiring trabeculectomy in a patient with a history of medically controlled glaucoma (n = 1), postoperative cystoid macular edema that resolved medically (n = 1) and graft failure 5 months postoperatively (n = 1). No patients developed pupillary block. Excluding graft failure (n = 1), preoperative amblyopia (n = 2) and premature loss to follow-up (n = 1), final corrected distance visual acuity was 0.18 ± 0.14 logMAR (~20/30 Snellen) with 44.4% reaching 6/7.5 (Snellen) or more.Conclusions:PI-Less DMEK is a safe, technically easy, and effective modification that avoids the time and complications associated with performing a PI before or during surgery.

中文翻译：

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“无 PI DMEK”：Descemet 膜内皮角膜移植术 (DMEK) 的结果，没有周边虹膜切开术

目的：评估 Descemet 膜内皮角膜移植术 (DMEK)，而无需在手术前或手术期间进行周边虹膜切开术 (PI)（“无 PI DMEK”）。材料和方法：这项回顾性研究包括连续接受无 PI DMEK 的患者2016 年 2 月至 2017 年 2 月期间，一名外科医生 (EL) 在三级医院拉宾医疗中心工作。评估术中和术后并发症。结果：纳入患者31例，平均年龄75.9±7.9岁，女性占58.1%。手术的主要适应症是假晶状体大疱性角膜病变 (18/31) 和 Fuchs 内皮营养不良 (9/31)。术前最佳矫正远视力为 1.13 ± 0.59 logMAR (~6/80 Snellen)。对于进行术后内皮细胞计数测量的 12/31，细胞损失为 49 ± 20%。术中并发症包括需要重新插入的移植物插入期间的前房 (AC) 前房积血 (n = 1)，以及角膜主切口的轻微前房积血 (n = 1)。术后 1.5 小时对所有患者进行部分裂隙灯排气。术后并发症包括需要重新冒泡的部分移植物脱离 (n = 5)、自我解决的最小外周移植物脱离 (n = 5)、有药物控制的青光眼病史的患者需要进行小梁切除术的不受控制的高眼压 (n = 1)、术后囊样医学上解决的黄斑水肿 (n = 1) 和术后 5 个月移植失败 (n = 1)。没有患者出现瞳孔阻滞。不包括移植失败 (n = 1)、术前弱视 (n = 2) 和过早失访 (n = 1)，