Researchers Evaluate Keratoplasty Procedure for Iridocorneal Endothelial Syndrome

A study reviews DMEK’s ability to treat iridocorneal endothelial syndrome and Fuchs’ endothelial dystrophy.

Short-term visual outcomes were “comparable,” for patients with iridocorneal endothelial (ICE) syndrome and Fuchs endothelial dystrophy (FED), following treatment with Descemet membrane endothelial keratoplasty (DMEK), a study demonstrates. However, DMEK for ICE syndrome had higher postoperative endothelial cell loss (ECL), according to the research published in the American Journal of Ophthalmology.

The prospective interventional comparative case series examined 68 eyes of 63 patients with ICE syndrome or FED enrolled at the Zhongshan Ophthalmic Center, Guangzhou, China between March 10, 2014 and May 11, 2018. DMEK was performed in all cases in 2 groups: an ICE syndrome group (eyes, 24; patients, 24) and FED group (eyes, 44; patients, 39). The following were recorded: corrected distance visual acuity (CDVA), endothelial cell loss (ECL), intraocular pressure (IOP), graft survival, and surgical complications. The ICE and FED groups had similar mean follow-up times (24.9 months ± 5 months and 25.2 months ± 7.7 months, respectively).

Investigators found that 1 year after surgery, Kaplan–Meier survival analysis demonstrated 85.7% and 100% cumulative graft success rates (P =.017) in patients with ICE and FED, respectively. Through the 12-month follow-up, postoperative CDVA level was comparable between the groups but following that, CDVA was better in the FED group (0.17 ± 0.08 logMAR vs 0.15 ± 0.1 logMAR at 12 months postoperatively, P <.001). That 12-month follow-up visit demonstrated that 37.5% (9/24) and 52.3% (23/44) of eyes reached a CDVA of 20/25 or better in the ICE and FED groups, respectively (P =.243). The average preoperative CDVA was similar in both groups (0.75 ± 0.12 logMAR in the ICE group and 0.91 ± 0.17 logMAR in the FED group, P <.001).

“Moreover, postoperative ECL was significantly higher in ICE group than in FED group throughout the follow-up period (P <.001),” according to the researchers. “A discernable increase in structural abnormalities of the anterior chamber angle was observed in 2 eyes (8.3%) in the ICE group; however, no significant differences were observed in the incidence of principal complications between the 2 groups.”


Wu J, Dong X, Ouyang C, et al. Comparison of Descemet membrane endothelial keratoplasty for iridocorneal endothelial syndrome and Fuchs endothelial dystrophy. Am J Ophthalmol. Published online February 4, 2021. doi:10.1016/j.ajo.2021.01.029