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Vitreomacular traction after phakic, pseudophakic, and triple DMEK surgery

Vitreomacular traction after phakic, pseudophakic, and triple DMEK surgery Graefe's Archive for Clinical and Experimental Ophthalmology (2023) 261:595–597 https://doi.org/10.1007/s00417-022-05821-4 LE T TER TO  THE   EDITOR Vitreomacular traction after phakic, pseudophakic, and triple DMEK surgery 1 1 1 1,2 Sarah B. Zwingelberg  · Stephanie Bresgen  · Claus Cursiefen  · Friederike Schaub Received: 30 April 2022 / Revised: 11 August 2022 / Accepted: 30 August 2022 / Published online: 15 September 2022 © The Author(s) 2022 Dear Editor, Key messages Vitreomacular traction (VMT) can cause vision loss after successful Descemet Membrane Endothelial Keratoplasty (DMEK). Preoperative VMTs regressed significantly more often 12 months after triple DMEK compared to pseudophakic and phakic DMEK. The use of gas (sulfur hexafluoride, SF6 20%) for anterior chamber tamponade tended to induce a complete posterior vitreous detachment more often in contrast to air tamponade. Posterior vitreous detachment (PVD) is a common phe- All consecutive eyes that underwent a first DMEK sur - nomenon in the aging eye. In some cases (PVD) is incom- gery between July 2011 and December 2018 at the Dept. plete and anomalous and may cause vitreomacular traction of Ophthalmology at the University of Cologne with a (VMT) with vision loss [1]. Known risk factors for develop- preoperative macular examination by SD-OCT available ing vitreomacular traction are increasing age, female gender, and having a minimum follow-up of 1 year were included. the degree of myopia, and previous surgery. There are sev- All eyes underwent macular examination using SD-OCT eral treatment options: observation, pharmacologic vitreoly- (SPECTRALIS® HRA + OCT, Heidelberg Engineering sis, vitrectomy, or pneumatic vitreolysis [2]. GmbH, Heidelberg, Germany) preoperatively and as well Descemet membrane endothelial keratoplasty (DMEK) as at each postoperative visit (1, 3, 6, 12 months). The currently is the surgical treatment of choice in corneal specific scan protocol was a custom raster scan pattern endothelial diseases [3]. In DMEK, the anterior chamber is with 37 Sects. (512 A-scans each) in a 30° × 20° field of tamponaded with air or gas. To date, the incidence of VMT view. Occurrence of VMT was defined as an incomplete, and the clinical course after corneal endothelial transplanta- but partial PVD temporal to the fovea with traction on the tion is unknown. fovea with edematous or cystic changes. For statistical The purpose of this retrospective study was to analyze the analysis, Student’s t-test was performed. incidence of anomalous PVD and the progression and devel- A total of 1076 patients were eligible for the study, opment of VMTs after different types of DMEK surgery. of which 57 eyes underwent a phakic DMEK (5.3%), 480 a pseudophakic DMEK (44.6%), and 539 a triple DMEK procedure The mean patient age overall cohort * Sarah B. Zwingelberg was 65.9 ± 6.3 years (50.1%). sarah.zwingelberg@uk-koeln.de The median follow-up time was 18.3 + 12.2 months. At Department of Ophthalmology, Faculty of Medicine the follow-up visit after 12 months in 62.9% OCT scans and University, Hospital of Cologne, University of Cologne, were available for evaluation. Kerpener Straße 62, 50937 Cologne, Germany The mean age of the total cohort was 65.9 ± 6.3 years. In University of Rostock, Department of Ophthalmology, the group of triple DMEK, mean age was 63.8 ± 8.5 years, Doberaner Str. 140, 18057 Rostock, Germany Vol.:(0123456789) 1 3 596 Graefe's Archive for Clinical and Experimental Ophthalmology (2023) 261:595–597 Fig. 1 Triple DMEK leads to fastest resolution of VMT after endothelial keratoplasty. Proportion of VMT over the entire period of 12 months with a continuous decrease in all patients (blue curve). Patients with triple DMEK procedure (red curve) showed a significant and continuous decrease of VMTs after surgery in phakic DMEK 61.9 ± 5.9, and in pseudophakic DMEK effect was also visible, especially postoperative: After 67.7 ± 7.7 years. 3  months, at least only 18% had a preoperative exist- Preoperatively, 6.5% (n = 70) showed a VMT. Tri- ing VMT with a decrease of the preoperative existing ple DMEK procedures (n = 46; 8.5%) showed a slightly VMTs, but increased again 6 months after DMEK from increased preoperative incidence of VMT compared to 18 to 20% and after 12  months up to 35%, while also pseudophakic (n = 13; 2.7%; p = 0.174) eyes. In the small new VMTs developed during the postoperative course. sample of phakic DMEK (n = 11; 19.3%; p = 0.125), In phakic DMEK, no significant change in the inci- VMT was even higher. After 3 months, just 55% of the dence of VMTs could be observed at any time. Espe- preoperative existing VMTs in triple DMEK were still cially in months 6 to 12, the VMTs showed an increase detectable and reduced again after 6 months to 50% and of 17%. Preoperative VMTs regressed in consequence finally decreased significantly to 22% after 12 months significantly more often 12 months after triple DMEK after DMEK surgery. In pseudophakic DMEK, the compared to the other two types of surgery (p = 0.013). Fig. 2 SF620% anterior chamber gas tamponade seems to support VMT resolution after DMEK. Proportion of VMT over the entire period of 12 months with a more sig- nificant decrease and successful PVD in eyes with gas (SF 20%) anterior chamber tamponade (green curve) compared to patients with air for graft attach- ment 1 3 Graefe's Archive for Clinical and Experimental Ophthalmology (2023) 261:595–597 597 Informed consent For this type of study, formal consent is not required. In contrast, 12  months after pseudophakic and phakic DMEK, there was a slightly increased incidence of VMT Conflict of interest The authors declare no competing interests. compared to preoperative incidence (pseudophakic: p = 0.091; phakic = 0.49, compare Fig. 1). Open Access This article is licensed under a Creative Commons Attri- The use of gas (sulfur hexafluoride, SF6 20%) for anterior bution 4.0 International License, which permits use, sharing, adapta- chamber tamponade tended to induce a complete PVD more tion, distribution and reproduction in any medium or format, as long often, whereas following air tamponade, the incidence of as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes VMT seemed to increase (compare Fig. 2). were made. The images or other third party material in this article are All PVDs in eyes with VMT were uncomplicated dur- included in the article's Creative Commons licence, unless indicated ing the course; in two cases, macular holes occurred within otherwise in a credit line to the material. If material is not included in 3 months after a triple DMEK procedure by using air for the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will anterior chamber tamponade. need to obtain permission directly from the copyright holder. To view a According to the general decrease of VMT incidence copy of this licence, visit http://cr eativ ecommons. or g/licen ses/ b y/4.0/ . after surgery shown in Fig.  1, it can be assumed that surgical manipulation in the anterior segment may favor a PVD and thereby VMT resolution. This observation References has already been demonstrated in the procedure of cata- ract surgeries [4]. This fact could be the reason why the 1. Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel incidence of VMTs before and after surgery is higher in E, Sadda SR, Sebag J, Spaide RF, Stalmans P (2013) The Inter- national Vitreomacular Traction Study Group classification of patients with phakic DMEK than in patients with a pseu- vitreomacular adhesion, traction, and macular hole. Ophthalmol- dophakic and triple DMEK. In addition, the intraocular ogy 120(12):2611–2619. https:// doi. org/ 10. 1016/j. ophtha. 2013. temperature may also play a significant role. PVD can 07. 042 rd also be induced by thermal effects that may occur during 2. Day S, Martinez JA, Harper CA et al (2016) 3 . Intravitreal sulfus hexafluorid injection for the treatment of vitreomacular traction phacoemulsification [5]. syndrome. Retina 36(4):733–737. https:// doi. org/ 10. 1097/ IAE. We could see a trend towards a higher resolving rate 00000 00000 000760 after anterior chamber gas tamponade. A potential expla- 3. FlockerziCursiefen C, Seitz B (2018) all German Keratoplasty nation could be the more expansive properties leading to a Registry Contributors. Trends in corneal transplantation from 2001 to 2016 in Germany: a report of the DOG-section cornea higher rate of mechanical vitreous detachment [3]. and its keratoplasty registry. Am J Ophthalmol 188:91–98. https:// Our study results represent the first data in a large doi. org/ 10. 1016/j. ajo. 2018. 01. 018 cohort of eyes with corneal endothelial diseases includ- 4. Ripandelli G, Coppé AM, Stirpe M et al (2007) Posterior vitreous ing observations of the vitreomacular interface by OCT. detachment and retinal detachment after cataract surgery. Ophthal- mology 114(4):692–697. https:// doi. org/ 10. 1016/j. ophtha. 2006. The choice of surgery technique seems to have an impact 08. 045 on the resolution and the development of VMT, so that 5. Chen K, Weiland JD (2013) Relationship between vitreous tem- this could be taken into account during surgery planning. perature and posterior vitreous detachment. J Mech Behav Biomed A more detailed analysis of the risk factors and clinical Mater 26:54–58. https:// doi. org/ 10. 1016/j. jmbbm. 2013. 05. 015 course of further vitreoretinal interface changes is desir- Publisher's note Springer Nature remains neutral with regard to able and should be evaluated in further studies. jurisdictional claims in published maps and institutional affiliations. Funding Open Access funding enabled and organized by Projekt DEAL. German Research Foundation (DFG) FOR2240 “(Lymph)- angiogenesis and Cellular Immunity in Inflammatory Diseases of the Eye” (CC, www . for22 40. de); EU COST Aniridia-net.eu (CC); EU Horizon 2020 ARREST BLINDNESS (CC). Declarations Ethical approval The study was approved by the local Institutional Review Board (14–373) and was conducted in adherence to the tenets of the Declaration of Helsinki. 1 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Graefe's Archive for Clinical and Experimental Ophthalmology Springer Journals

Vitreomacular traction after phakic, pseudophakic, and triple DMEK surgery

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Springer Journals
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Copyright © The Author(s) 2022
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0721-832X
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1435-702X
DOI
10.1007/s00417-022-05821-4
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Abstract

Graefe's Archive for Clinical and Experimental Ophthalmology (2023) 261:595–597 https://doi.org/10.1007/s00417-022-05821-4 LE T TER TO  THE   EDITOR Vitreomacular traction after phakic, pseudophakic, and triple DMEK surgery 1 1 1 1,2 Sarah B. Zwingelberg  · Stephanie Bresgen  · Claus Cursiefen  · Friederike Schaub Received: 30 April 2022 / Revised: 11 August 2022 / Accepted: 30 August 2022 / Published online: 15 September 2022 © The Author(s) 2022 Dear Editor, Key messages Vitreomacular traction (VMT) can cause vision loss after successful Descemet Membrane Endothelial Keratoplasty (DMEK). Preoperative VMTs regressed significantly more often 12 months after triple DMEK compared to pseudophakic and phakic DMEK. The use of gas (sulfur hexafluoride, SF6 20%) for anterior chamber tamponade tended to induce a complete posterior vitreous detachment more often in contrast to air tamponade. Posterior vitreous detachment (PVD) is a common phe- All consecutive eyes that underwent a first DMEK sur - nomenon in the aging eye. In some cases (PVD) is incom- gery between July 2011 and December 2018 at the Dept. plete and anomalous and may cause vitreomacular traction of Ophthalmology at the University of Cologne with a (VMT) with vision loss [1]. Known risk factors for develop- preoperative macular examination by SD-OCT available ing vitreomacular traction are increasing age, female gender, and having a minimum follow-up of 1 year were included. the degree of myopia, and previous surgery. There are sev- All eyes underwent macular examination using SD-OCT eral treatment options: observation, pharmacologic vitreoly- (SPECTRALIS® HRA + OCT, Heidelberg Engineering sis, vitrectomy, or pneumatic vitreolysis [2]. GmbH, Heidelberg, Germany) preoperatively and as well Descemet membrane endothelial keratoplasty (DMEK) as at each postoperative visit (1, 3, 6, 12 months). The currently is the surgical treatment of choice in corneal specific scan protocol was a custom raster scan pattern endothelial diseases [3]. In DMEK, the anterior chamber is with 37 Sects. (512 A-scans each) in a 30° × 20° field of tamponaded with air or gas. To date, the incidence of VMT view. Occurrence of VMT was defined as an incomplete, and the clinical course after corneal endothelial transplanta- but partial PVD temporal to the fovea with traction on the tion is unknown. fovea with edematous or cystic changes. For statistical The purpose of this retrospective study was to analyze the analysis, Student’s t-test was performed. incidence of anomalous PVD and the progression and devel- A total of 1076 patients were eligible for the study, opment of VMTs after different types of DMEK surgery. of which 57 eyes underwent a phakic DMEK (5.3%), 480 a pseudophakic DMEK (44.6%), and 539 a triple DMEK procedure The mean patient age overall cohort * Sarah B. Zwingelberg was 65.9 ± 6.3 years (50.1%). sarah.zwingelberg@uk-koeln.de The median follow-up time was 18.3 + 12.2 months. At Department of Ophthalmology, Faculty of Medicine the follow-up visit after 12 months in 62.9% OCT scans and University, Hospital of Cologne, University of Cologne, were available for evaluation. Kerpener Straße 62, 50937 Cologne, Germany The mean age of the total cohort was 65.9 ± 6.3 years. In University of Rostock, Department of Ophthalmology, the group of triple DMEK, mean age was 63.8 ± 8.5 years, Doberaner Str. 140, 18057 Rostock, Germany Vol.:(0123456789) 1 3 596 Graefe's Archive for Clinical and Experimental Ophthalmology (2023) 261:595–597 Fig. 1 Triple DMEK leads to fastest resolution of VMT after endothelial keratoplasty. Proportion of VMT over the entire period of 12 months with a continuous decrease in all patients (blue curve). Patients with triple DMEK procedure (red curve) showed a significant and continuous decrease of VMTs after surgery in phakic DMEK 61.9 ± 5.9, and in pseudophakic DMEK effect was also visible, especially postoperative: After 67.7 ± 7.7 years. 3  months, at least only 18% had a preoperative exist- Preoperatively, 6.5% (n = 70) showed a VMT. Tri- ing VMT with a decrease of the preoperative existing ple DMEK procedures (n = 46; 8.5%) showed a slightly VMTs, but increased again 6 months after DMEK from increased preoperative incidence of VMT compared to 18 to 20% and after 12  months up to 35%, while also pseudophakic (n = 13; 2.7%; p = 0.174) eyes. In the small new VMTs developed during the postoperative course. sample of phakic DMEK (n = 11; 19.3%; p = 0.125), In phakic DMEK, no significant change in the inci- VMT was even higher. After 3 months, just 55% of the dence of VMTs could be observed at any time. Espe- preoperative existing VMTs in triple DMEK were still cially in months 6 to 12, the VMTs showed an increase detectable and reduced again after 6 months to 50% and of 17%. Preoperative VMTs regressed in consequence finally decreased significantly to 22% after 12 months significantly more often 12 months after triple DMEK after DMEK surgery. In pseudophakic DMEK, the compared to the other two types of surgery (p = 0.013). Fig. 2 SF620% anterior chamber gas tamponade seems to support VMT resolution after DMEK. Proportion of VMT over the entire period of 12 months with a more sig- nificant decrease and successful PVD in eyes with gas (SF 20%) anterior chamber tamponade (green curve) compared to patients with air for graft attach- ment 1 3 Graefe's Archive for Clinical and Experimental Ophthalmology (2023) 261:595–597 597 Informed consent For this type of study, formal consent is not required. In contrast, 12  months after pseudophakic and phakic DMEK, there was a slightly increased incidence of VMT Conflict of interest The authors declare no competing interests. compared to preoperative incidence (pseudophakic: p = 0.091; phakic = 0.49, compare Fig. 1). Open Access This article is licensed under a Creative Commons Attri- The use of gas (sulfur hexafluoride, SF6 20%) for anterior bution 4.0 International License, which permits use, sharing, adapta- chamber tamponade tended to induce a complete PVD more tion, distribution and reproduction in any medium or format, as long often, whereas following air tamponade, the incidence of as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes VMT seemed to increase (compare Fig. 2). were made. The images or other third party material in this article are All PVDs in eyes with VMT were uncomplicated dur- included in the article's Creative Commons licence, unless indicated ing the course; in two cases, macular holes occurred within otherwise in a credit line to the material. If material is not included in 3 months after a triple DMEK procedure by using air for the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will anterior chamber tamponade. need to obtain permission directly from the copyright holder. To view a According to the general decrease of VMT incidence copy of this licence, visit http://cr eativ ecommons. or g/licen ses/ b y/4.0/ . after surgery shown in Fig.  1, it can be assumed that surgical manipulation in the anterior segment may favor a PVD and thereby VMT resolution. This observation References has already been demonstrated in the procedure of cata- ract surgeries [4]. This fact could be the reason why the 1. Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel incidence of VMTs before and after surgery is higher in E, Sadda SR, Sebag J, Spaide RF, Stalmans P (2013) The Inter- national Vitreomacular Traction Study Group classification of patients with phakic DMEK than in patients with a pseu- vitreomacular adhesion, traction, and macular hole. Ophthalmol- dophakic and triple DMEK. In addition, the intraocular ogy 120(12):2611–2619. https:// doi. org/ 10. 1016/j. ophtha. 2013. temperature may also play a significant role. PVD can 07. 042 rd also be induced by thermal effects that may occur during 2. Day S, Martinez JA, Harper CA et al (2016) 3 . Intravitreal sulfus hexafluorid injection for the treatment of vitreomacular traction phacoemulsification [5]. syndrome. Retina 36(4):733–737. https:// doi. org/ 10. 1097/ IAE. We could see a trend towards a higher resolving rate 00000 00000 000760 after anterior chamber gas tamponade. A potential expla- 3. FlockerziCursiefen C, Seitz B (2018) all German Keratoplasty nation could be the more expansive properties leading to a Registry Contributors. Trends in corneal transplantation from 2001 to 2016 in Germany: a report of the DOG-section cornea higher rate of mechanical vitreous detachment [3]. and its keratoplasty registry. Am J Ophthalmol 188:91–98. https:// Our study results represent the first data in a large doi. org/ 10. 1016/j. ajo. 2018. 01. 018 cohort of eyes with corneal endothelial diseases includ- 4. Ripandelli G, Coppé AM, Stirpe M et al (2007) Posterior vitreous ing observations of the vitreomacular interface by OCT. detachment and retinal detachment after cataract surgery. Ophthal- mology 114(4):692–697. https:// doi. org/ 10. 1016/j. ophtha. 2006. The choice of surgery technique seems to have an impact 08. 045 on the resolution and the development of VMT, so that 5. Chen K, Weiland JD (2013) Relationship between vitreous tem- this could be taken into account during surgery planning. perature and posterior vitreous detachment. J Mech Behav Biomed A more detailed analysis of the risk factors and clinical Mater 26:54–58. https:// doi. org/ 10. 1016/j. jmbbm. 2013. 05. 015 course of further vitreoretinal interface changes is desir- Publisher's note Springer Nature remains neutral with regard to able and should be evaluated in further studies. jurisdictional claims in published maps and institutional affiliations. Funding Open Access funding enabled and organized by Projekt DEAL. German Research Foundation (DFG) FOR2240 “(Lymph)- angiogenesis and Cellular Immunity in Inflammatory Diseases of the Eye” (CC, www . for22 40. de); EU COST Aniridia-net.eu (CC); EU Horizon 2020 ARREST BLINDNESS (CC). Declarations Ethical approval The study was approved by the local Institutional Review Board (14–373) and was conducted in adherence to the tenets of the Declaration of Helsinki. 1 3

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Graefe's Archive for Clinical and Experimental OphthalmologySpringer Journals

Published: Feb 1, 2023

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