June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Multicenter Study on Descemet membrane endothelial keratoplasty (DMEK)
Author Affiliations & Notes
  • Silke Oellerich
    Netherlands Institute for Innovative Ocular Surgery , Rotterdam, Netherlands
  • Lamis Baydoun
    Netherlands Institute for Innovative Ocular Surgery , Rotterdam, Netherlands
  • Jack Parker
    Netherlands Institute for Innovative Ocular Surgery , Rotterdam, Netherlands
  • Perry S Binder
    Gavin Herbert Eye Institute, Irvine, California, United States
  • Gerrit Melles
    Netherlands Institute for Innovative Ocular Surgery , Rotterdam, Netherlands
  • Footnotes
    Commercial Relationships   Silke Oellerich, None; Lamis Baydoun, DORC International (C); Jack Parker, DORC International (C); Perry Binder, None; Gerrit Melles, DORC International/Dutch Ophthalmic (C), SurgiCube International (C)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 4783. doi:
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    • Get Citation

      Silke Oellerich, Lamis Baydoun, Jack Parker, Perry S Binder, Gerrit Melles; Multicenter Study on Descemet membrane endothelial keratoplasty (DMEK). Invest. Ophthalmol. Vis. Sci. 2017;58(8):4783.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Endothelial keratoplasty (EK) has replaced penetrating keratoplasty as the standard treatment method for endothelial disorders over the last years. Since Descemet membrane endothelial keratoplasty (DMEK), the most selective EK technique, is gaining more and more popularity, with this retrospective, multicenter interventional cohort study we want to document the current surgical approach, clinical outcomes and complications of standardized ‘no-touch’ DMEK in eyes operated by starting as well as experienced corneal surgeons.

Methods : A total of 2,485 eyes undergoing DMEK for Fuchs’ endothelial corneal dystrophy (74%), bullous keratopathy (17%), failed previous transplants (8%), or unspecified indications (1%) were included in this study. The ‘no-touch’ DMEK surgeries were performed by 55 different surgeons in 23 countries. Main outcome measures were best corrected visual acuity (BCVA), endothelial cell density (ECD), and intra- and postoperative complications.

Results : After DMEK, BCVA improved in 87% of eyes, remained unchanged in 6%, and deteriorated in 7% of eyes (n=2,102). At 6 months, 71% of eyes reached a BCVA of ≥20/40 (≥0.5), 43% ≥20/25 (≥0.8), and 24% ≥20/20 (≥1.0) (n=2,126). Postoperative ECD averaged 1,575 (±489) cells/mm2 (n=1,405) representing a decrease of 40 (±19) % compared to preoperative cell counts (n=1,272, P<0.05). Intraoperative complications were reported for 9% of eyes including difficulties in graft maneuvering (3%) and intraoperative hemorrhage (1%). Graft detachment was the most common postoperative complication (27%). A re-bubbling procedure was performed in 20% of eyes; 14% of eyes required a secondary keratoplasty within the first six months. Surgeons that had performed >100 DMEK surgeries had lower intra- and postoperative complications rates than surgeons with fewer than 25 DMEK surgeries (P<0.05).

Conclusions : Our study showed that the standardized ‘no-touch’ DMEK technique is feasible for surgeons in various clinical and surgical settings. After a learning curve of about 25 cases, clinical outcomes improve and postoperative complication rates are lower.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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