Impact of Iridotomy/Iridectomy Size on Postoperative Pupillary Block and Dysphotopsia Following DMEK

Descemet membrane endothelial keratoplasty (DMEK) is the standard surgical treatment for corneal endothelial disorders. A postoperative pupillary block may occur despite routine preoperative laser iridotomy or intraoperative surgical iridectomy. Insufficient size or incomplete patency of the iridotomy/iridectomy (IT) may contribute to this complication, while excessively large openings may be associated with postoperative dysphotopsia. This prospective observational study investigates the association between IT size measured by anterior segment optical coherence tomography (AS-OCT) and the occurrence of postoperative pupillary block and dysphotopsia after DMEK.

Inclusion Criteria: * Adults aged ≥ 18 years * Patients undergoing Descemet membrane endothelial keratoplasty (DMEK) at the Department of Ophthalmology, University Hospital Leipzig * Preoperative Nd:YAG laser iridotomy or intraoperative surgical iridectomy performed as part of standard care * Ability to provide written informed consent * Willingness to complete the postoperative dysphotopsia questionnaire Exclusion Criteria: * Inability to provide informed consent or refusal to participate * Pre-existing surgical iridectomy * Missing or incomplete preoperative or postoperative anterior segment OCT data * Active anterior uveitis or panuveitis at the time of surgery