{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T17:50:58Z","timestamp":1777139458969,"version":"3.51.4"},"reference-count":46,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T00:00:00Z","timestamp":1730851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: This study aimed to describe the outcomes of a staged procedure combining Descemet membrane endothelial keratoplasty (DMEK) and sutureless scleral fixation (SSF) of a one-piece intraocular lens (IOL) in a case series. Co-performing endothelial keratoplasty (EK) and SSF is associated with intraoperative and postoperative complications such as graft deployment difficulties, air migration, graft detachment, and IOL opacification or tilt, all of which are evaluated in this study. Methods: This is a retrospective observational case series. Clinical data were collected from eight eyes of eight patients who underwent DMEK for endothelial failure and had previously received an SSF with one-piece IOL following complete vitrectomy. During DMEK surgery, an air leak test was conducted to check for air migration into the posterior chamber. If instability was detected, pupilloplasty was performed. Intraoperative and postoperative data, including DMEK graft unfolding time, were collected. Corrected Distance Visual Acuity (CDVA), refraction, endothelial cell density (ECD), central corneal thickness (CCT), intraocular pressure (IOP), and complications were recorded over a 12-month follow-up period. Results: We performed pupilloplasty in four patients (50%). The median CDVA improved from preoperative 0.85 logMAR (range: 0.60 to 1.00) at baseline to 0.18 logMAR (range: 0.10 to 0.70, p = 0.012) at 12 months. The median refraction value changed significantly from \u22121.00 to \u22120.50 at 12 months. The median percentage reduction in ECD after 12 months was 33.4% (range 30 to 40). The median baseline CCT was 689 \u03bcm (range: 651 to 701) at baseline visit and 541.5 \u03bcm (range: 525 to 591, p = 0.008) at 12 months. The median IOP was reduced significantly during follow-up. The median graft unfolding time was 6 min (5 to 9). One patient required rebubbling for partial detachment on postoperative day one. No complications occurred within 12 months. Conclusions: The effective compartmentalization of the anterior and posterior chambers in vitrectomized eyes with an SSF one-piece IOL and pupilloplasty can facilitate critical steps of DMEK surgery in complex eyes. Additionally, the air leak test could prove useful in identifying the need for iris-lens diaphragm reconstruction.<\/jats:p>","DOI":"10.3390\/jcm13226654","type":"journal-article","created":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T06:27:39Z","timestamp":1730874459000},"page":"6654","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy of Sutureless Scleral Fixation of One-Piece T-Shaped Haptic Intraocular Lens in Maintaining Anterior Chamber Stability During Descemet Membrane Endothelial Keratoplasty in Vitrectomized Eyes: Leak Test and Iris Diaphragm Reconstruction"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9061-0050","authenticated-orcid":false,"given":"Agostino Salvatore","family":"Vaiano","sequence":"first","affiliation":[{"name":"Institute of Ophthalmology, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Greco","sequence":"additional","affiliation":[{"name":"Institute of Ophthalmology, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0120-2341","authenticated-orcid":false,"given":"Maria","family":"Marenco","sequence":"additional","affiliation":[{"name":"Institute of Ophthalmology, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Greco","sequence":"additional","affiliation":[{"name":"Institute of Ophthalmology, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3037-2835","authenticated-orcid":false,"given":"Alessandro","family":"De Filippis","sequence":"additional","affiliation":[{"name":"Institute of Ophthalmology, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Garavelli","sequence":"additional","affiliation":[{"name":"Institute of Ophthalmology, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8019-712X","authenticated-orcid":false,"given":"Riccardo","family":"Merli","sequence":"additional","affiliation":[{"name":"Institute of Ophthalmology, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vito","family":"Romano","sequence":"additional","affiliation":[{"name":"Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Viale Europa 15, 25123 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.1097\/ICO.0b013e3182a0a307","article-title":"Evolution of endothelial keratoplasty","volume":"32","author":"Price","year":"2013","journal-title":"Cornea"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1097\/ICO.0000000000000625","article-title":"Feasibility and Outcome of Descemet Membrane Endothelial Keratoplasty in Complex Anterior Segment and Vitreous Disease","volume":"34","author":"Weller","year":"2015","journal-title":"Cornea"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/ICO.0000000000000288","article-title":"Descemet membrane endothelial keratoplasty in vitrectomized eyes: Clinical results","volume":"34","author":"Yoeruek","year":"2015","journal-title":"Cornea"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1097\/ICO.0000000000002024","article-title":"C-Press Technique to Facilitate Descemet Membrane Endothelial Keratoplasty Surgery in Vitrectomized Patients: A Case Series","volume":"38","author":"Saad","year":"2019","journal-title":"Cornea"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"101882","DOI":"10.1016\/j.ajoc.2023.101882","article-title":"Descemet Membrane Endothelial Keratoplasty with cornea press technique and implantation of a Carlevale scleral-fixated intraocular lens","volume":"32","author":"Ghazal","year":"2023","journal-title":"Am. 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Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6654\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:27:08Z","timestamp":1760113628000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6654"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,6]]},"references-count":46,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13226654"],"URL":"https:\/\/doi.org\/10.3390\/jcm13226654","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,6]]}}}