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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)
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.
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.
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).
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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