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Philip James Sanchez, Christopher Sanchez Sales, Zachary Mayko, Michael D Straiko, Mark A Terry; Survey of corneal surgeons following a DMEK training course. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1205.
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© ARVO (1962-2015); The Authors (2016-present)
Descemet membrane endothelial keratoplasty (DMEK) surgery is quickly gaining popularity over Descemet stripping automated endothelial keratoplasty (DSAEK) as the treatment of choice for Fuchs endothelial dystrophy and pseudophakic bullous keratopathy. However, many surgeons are apprehensive about learning the new techniques necessary for this procedure. The purpose of this study is to assess the results of DMEK skills transfer courses at a single institution utilizing a standardized DMEK technique and wet-lab practice.
We released a survey consisting of 15 questions related to surgical technique and immediate patient outcomes designed to determine surgeon success following a DMEK training course offered at a single center (Devers Eye Institute, Portland, OR). The survey was given to surgeons having taken the course a minimum of 1 month prior. Results were gathered so that we were blind to the identity of all respondents and surgical centers. The survey was given to a total of 43 surgeons who took the DMEK training course between May 2013 and August 2015. These survey responses were collected and coded for analysis. Responses regarding surgery successes or complications were analyzed only for respondents who reported performing DMEK surgery.
Of the 43 surgeons who participated in DMEK training at Devers, 25 responded to the survey request. Following the surgical training, 76% (20/25) of respondents reported performing DMEK surgery, with a total of 367 cases among the group. The standardized technique taught at Devers was used by 84% of the respondents. Among all cases performed by the responding surgeons, the rebubble rate was 15%, the graft failure rate was 5%, the total rejection rate was 0.5%, and the rate of pupillary block was 1.4%. With regard to surgeon attitudes about DMEK, 54% believed that DMEK is more difficult than DSAEK (all had learned DSAEK prior to DMEK), 68% thought that DMEK yielded better outcomes for their patients, and 26% had performed DMEK in complex cases.
Following a short, individual DMEK instructional course at a single institution, the majority of surgeons began performing DMEK with success. As a cohort, surgeons had complication rates similar to those published by high-volume DMEK centers, and perceived that the DMEK procedure yielded better outcomes for their patients than DSAEK.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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