Descemet membrane endothelial keratoplasty in patients after radiation therapy for uveal melanoma

PURPOSE : To evaluate the visual outcomes and postoperative complications after Descemet membrane endothelial keratoplasty (DMEK) in patients after radiation therapy for uveal melanoma. METHODS : In this retrospective observational study, 9 eyes of 9 patients after radiation therapy for uveal melanoma who received DMEK surgery at the Charité – Universitätsmedizin Berlin were included. Preoperative patients` characteristics were analyzed. Postoperative results including visual acuity and endothelial cell density and complications were evaluated. RESULTS : Best-corrected visual acuity improved 3, 12 and 24 months after DMEK (preoperative: 0.88±0.47 logMAR, after 3 months: 0.52±0.30 (p=0.049), after 12 months: 0.60±0.35 logMAR (p=0.66), after 24 months: 0.60±0.45 logMAR (p=0.357)) compared to preoperatively. Endothelial cell density decreased 3 and 12 months after DMEK (preoperative: 2327±242 cells/mm ² , after 3 months: 1831±384 cells/mm ² (p=0.068), after 12 months: 1350±996 cells/mm ² (p=0.180)). Re-bubbling was performed in 55.6% of eyes after DMEK. One patient developed a postoperative macular edema, and another one a distant metastasis of the liver 20 years after last tumor treatment. Two-year-incidence of graft rejection was 0%, of graft failure 25.0% (95%KI -17.5%, 67.5%), of IOP-elevation 55.6% (95% KI 12.1%, 99.1%) and post-DMEK glaucoma 16.7% (95%KI -13.1%, 46.5%). CONCLUSIONS : Our results confirm that DMEK surgery is feasible and improves the visual acuity in patients with local control of uveal melanoma after radiation therapy. However, the complications rate is high - including graft failure, postoperative IOP elevation and post-DMEK glaucoma - and complications of the radiation treatment limit the achievable visual acuity.