Intracameral Enoxaparin for Descemet Membrane Endothelial Keratoplasty: A Pilot Safety Study

Intracameral Enoxaparin for Descemet Membrane Endothelial Keratoplasty: A Pilot Safety Study

Study Overview

The goal of this study was to assess the safety and results of using intracameral enoxaparin during Descemet membrane endothelial keratoplasty (DMEK).

Methods

The study included two parts: a clinical multicenter retrospective cohort arm (CA) and an ex vivo basic science arm (BSA). In the CA, DMEK procedures were performed by 6 skilled corneal surgeons across various locations. Intracameral enoxaparin (40 mg/500 mL) was added to the irrigation fluid for all surgeries. Outcomes were evaluated at 6 and 12 months. In the BSA, graft pairs were randomly assigned to either control or enoxaparin treatment and analyzed for endothelial cell death and stress.

Results

In the cohort arm, the average age of 159 eyes from 134 patients was 69.3 years, primarily diagnosed with Fuchs dystrophy. The average best-corrected visual acuity (BCVA) improved significantly from 0.42 to 0.1 logMAR at 12 months. At 6 months, 58.4% of patients achieved a BCVA of 20/25 or better, and 91% improved to 20/40 or better. The rebubble rate was 13%, with 6 eyes needing multiple rebubbles. Only one case of total graft detachment occurred, and there were no reports of bleeding during or after surgery. In the BSA, enoxaparin did not significantly affect cell death or stress compared to the control group.

Conclusions

Enoxaparin can be safely used in DMEK surgery without increasing the risk of bleeding, graft failure, or cell toxicity.

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