Browsing by Author "Dias-Santos, Arnaldo"
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- Descemet’s membrane endothelial keratoplasty for corneal endothelial failure secondary to three types of phakic intraocular lens: retrospective studyPublication . Moura-Coelho, Nuno; Cunha, João Paulo; Dias-Santos, Arnaldo; Dutra-Medeiros, Marco; Papa-Vettorazzi, Renato; Manero, Felicidad; Güell, JoséPurpose: To analyze the outcomes of Descemet's membrane endothelial keratoplasty (DMEK) for corneal endothelial failure secondary to phakic intraocular lens implantation (PIOL) at a reference center for corneal transplantation in Spain. Design: Retrospective, single-surgeon case series. Methods: Single-center analysis of patients who underwent DMEK for PIOL-related corneal decompensation between July 2011 and July 2020 with at least 6 months of follow-up postoperatively. The primary outcome was the final best-corrected visual acuity (BCVA, logMAR) compared to pre-DMEK BCVA. Secondary outcomes analyzed included post-DMEK refractive spherical equivalent, endothelial cell loss (%ECL), and graft failure. Results: Sixteen eyes (14 patients) underwent DMEK for PIOL-related corneal decompensation. The Mean (SD) time to PIOL explantation was 9.3 (5.0) years, and the median (P25-P75) time between PIOL explantation and DMEK surgery was 3 (2-4) months. Median pre-DMEK BCVA was 0.80 (1.08-0.60) logMAR. A statistically significant improvement in BCVA was observed 1 month after DMEK (p = 0.001), and the median final BCVA was 0.15 (0.0-0.35) logMAR (p = 0.002). The mean %ECL was 55.6 (18.7) % at 2-year follow-up and 61.7 (11.7) % in eyes with over 4 years of follow-up. Two eyes required re-bubbling (12.5%), one of which ended in primary graft failure (6.2%) and one eye had late endothelial graft failure (LEGF) at 4-year follow-up (1/15 grafts, 6.7%). Conclusion: In patients with PIOL-related corneal decompensation, DMEK leads to good and clinically significant refractive and visual outcomes in the medium-long term, with a good safety profile. Prospective studies are encouraged to ascertain whether these cases are at increased risk of accelerated endothelial cell loss and LEGF.
- Outcomes of cystoid macular edema following Descemet’s membrane endothelial keratoplasty in a referral center for keratoplasty in Spain: retrospective studyPublication . Moura-Coelho, Nuno; Papa-Vettorazzi, Renato; Santiesteban-García, Imalvet; Dias-Santos, Arnaldo; Manero, Felicidad; Cunha, João Paulo; Güell, JoséThe aim of this study was to analyze the outcomes of eyes with visually significant cystoid macular œdema (vs-CMO) after Descemet membrane endothelial keratoplasty (DMEK) in a referral center for keratoplasty in Spain. We conducted a retrospective, single-surgeon case series of eyes that developed post-DMEK vs-CMO performed between January 2011 and December 2020. Data collected included: indication for DMEK; biometric data; ocular comorbidities; past medical history; time to detection of vs-CMO after DMEK (T, weeks); best-corrected visual acuity (BCVA, logMAR) and central retinal thickness (CRT, µm) at diagnosis of vs-CMO, after resolution of CMO, and at last follow-up; and management strategy. The main outcomes analyzed were the incidence of vs-CMO and improvement in BCVA and CRT after treatment of vs-CMO. Of 291 consecutive DMEK surgeries, 14 eyes of 13 patients (4.8%) developed vs-CMO. Five patients (38.5%) had a history of CMO, and 28.6% of eyes had ophthalmic comorbidities. Median (P25-P75) T was 4 (3-10) weeks. Treatment success was observed in 12/13 eyes (92.3%), two of which required second-line treatment. In successful cases (median time-to-resolution 3.0 (2.0-3.5) months), median BCVA improved from 0.60 (0.40-0.80) logMAR to 0.30 (0.15-0.40) logMAR (p = 0.002) after treatment, and median CRT improved from 582.5 (400.0-655.0) µm to 278.0 (258.0-294.0) µm (p = 0.005). In our study, we found a 4.8% rate of post-DMEK vs-CMO, with most cases occurring in the first 3 months after surgery. Good functional and anatomical outcomes are expected in most eyes, without treatment-related complications or implications in graft outcomes. Additional studies are encouraged to determine a standardized protocol for post-DMEK vs-CMO.
- Predictive factors of long-term visual outcomes after primary Descemet’s membrane endothelial keratoplasty (DMEK): retrospective studyPublication . Moura-Coelho, Nuno; Papa-Vettorazzi, Renato; Dias-Santos, Arnaldo; Cunha, João Paulo; Dutra-Medeiros, Marco; Manero, Felicidad; Güell, José LuisPurpose: To determine predictive factors of higher levels of best-corrected visual acuity (BCVA) in the long-term after primary Descemet's membrane endothelial keratoplasty (DMEK). Methods: Retrospective, single-surgeon case series of 129 successful primary DMEK eyes without graft failure and with a minimum postoperative follow-up of 12 months. A mixed effect model for repeated measurements (MMRM) analysis was performed to determine recipient, donor, surgical, and postoperative factors associated with BCVA ≤ 0.10 logMAR (≥ 20/25 Snellen). Results: After primary DMEK, there was a statistically significant improvement in BCVA with a global reduction in logMAR BCVA (p < 0.00001). There was also a global tendency towards increasing the proportion of eyes with BCVA ≤ 0.10 logMAR at all time points (p < 0.00001), from 1.6% before DMEK to 64.4% in eyes with more than 5 years of F-U. The absence of retinal disease was associated with a decrease of 0.10 logMAR in postoperative BCVA after primary DMEK, maintaining constant the rest of the variables (p < 0.001). The variables age (OR 0.960), postoperative time (OR 1.083), preoperative BCVA ≥ 0.375 logMAR (OR 0.162), and indication for DMEK (OR 5.412) were included in the predictive MMRM model of BCVA ≤ 0.10 logMAR. Conclusion: Primary DMEK is associated with statistically and clinically significant improvement in BCVA that occurs early in the postoperative period and is continuous over time. Eyes with retinal comorbidities have an increased risk of worse postoperative BCVA after DMEK. Younger recipient age, Fuchs' dystrophy eyes, and eyes with better preoperative BCVA are more likely to achieve postoperative BCVA ≤ 0.10 logMAR.