April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Learning Curve in Descemet’s Membrane Endothelial Keratoplasty (DMEK): Early Complications and 6 Month Results
Author Affiliations & Notes
  • Lloyd M Cuzzo
    Ophthalmology, USC Eye Institute/University of Southern California Keck School of Medicine, Los Angeles, CA
  • Jennifer C Lee
    Ophthalmology, USC Eye Institute/University of Southern California Keck School of Medicine, Los Angeles, CA
  • Neda Shamie
    Ophthalmology, USC Eye Institute/University of Southern California Keck School of Medicine, Los Angeles, CA
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 889. doi:
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      Lloyd M Cuzzo, Jennifer C Lee, Neda Shamie; Learning Curve in Descemet’s Membrane Endothelial Keratoplasty (DMEK): Early Complications and 6 Month Results. Invest. Ophthalmol. Vis. Sci. 2014;55(13):889.

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

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Abstract

Purpose: To evaluate the outcome and early complications of DMEK in a single surgeon’s learning curve.

Methods: Retrospective, nonrandomized, clinical study at a tertiary referral center. In a first group of 35 consecutive eyes (20 with Fuchs’ endothelial dystrophy, 14 with pseudophakic bullous keratopathy, and 1 with a Descemet’s membrane tear) DMEK was performed by a single surgeon. Early complications and 6 month results were evaluated. Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD), and intra and postoperative complications. Average BCVA was calculated by converting snellen visual acuity to logMAR, averaging the logMAR’s, and then converting back to snellen visual acuity.

Results: Early complications including iatrogenic primary graft failure (IPGF), graft separation/detachment requiring rebubbling, pupillary block, reversed graft positioning and other complications were evaluated. Five out of 35 (14%) eyes required one rebubbling to obtain graft adhesion. No IPGF, upside down graft, nor pupillary block occurred. Average pre-stripping endothelial cell count before DMEK was 2581 cells/square millimeter and 2540 cells/square millimeter six months post-operatively. The average endothelial cell loss was 2% at 6 months after DMEK. Average BCVA was 20/25 at 6 months after DMEK compared to 20/60 before surgery. Seventy-five percent of cases achieved a BCVA of 20/25 or better at 6 months post-operatively.

Conclusions: Even during a single surgeon’s learning curve in DMEK, acceptable results can be achieved with low complication rates and excellent visual outcomes.

Keywords: 481 cornea: endothelium • 462 clinical (human) or epidemiologic studies: outcomes/complications • 479 cornea: clinical science  
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