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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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To evaluate the outcome and early complications of DMEK in a single surgeon’s learning curve.
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.
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.
Even during a single surgeon’s learning curve in DMEK, acceptable results can be achieved with low complication rates and excellent visual outcomes.
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