Medication

For the first week after DMEK surgery, patients received dexamethasone-dihydrogen-phosphate disodium 1.0 mg/ml and gentamicin-sulfate 5.0 mg/ml eye drops five times daily and prednisolone acetate 10.0 mg/ml eye drops (Inflanefran forte, Allergan, Dublin, Ireland), five times daily. Pilocarpine hydrochloride 20.0 mg/ml eye drops were applied preoperatively and twice daily during the time of gas in the AC after surgery to induce miosis and reduce the contact of gas to the anterior surface of the IOL, which has been associated with calcium phosphate depositions, particularly in hydrophilic IOLs [27–30]. After the first month, only prednisolone acetate 10.0 mg/ml eye drops were continued. These were tapered by one drop every month to a maintenance dose of once daily.

In case of DMEK-ME nepafenac 1.0 mg/ml eye drops (Nevanac 1 mg/ml, Novartis, Basel, Switzerland) three times daily was added. Nepafenac was continued until complete resolution of DMEK-ME, then tapered by one drop weekly. All DMEK-MEs responded to topical treatment; no further treatment was needed.