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Christoph Holtmann, Kristina Spaniol, Inga Neumann, Darya Savinova, Kulp Lisa, Gerd Geerling; Outcome after Descemet Membrane Endothelial Keratoplasty (DMEK) during a one surgeon learning curve converting from DSAEK.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):891.
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© ARVO (1962-2015); The Authors (2016-present)
Descemet Membrane Endothelial Keratoplasty is rapidly gaining acceptance for corneal endothelial disease replacing Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in many centers as the treatment of choice. Here we evaluate the first 50 cases of a single surgeon converting from DSAEK to DMEK as the primary procedure for Fuchs Endothelial Keratopathy and bullous Keratopathy.
The clinical records of the first 50 patients (50 eyes) undergoing DMEK surgery by a single, experienced DSAEK-surgeon performed between January 2012 and September 2013 were analyzed retrospectively. Pre- and postoperative parameters including lens status, best-corrected visual acuity (BCVA, in logarithm of the minimal angle of resolution [logMAR] units), central corneal thickness (CCT, analyzed by Scheimpflug imaging), endothelial cell count (ECC), intraocular pressure (IOP, measured by Goldmann applanation tonometry), graft dislocation and rate of re-bubbling were evaluated.
41 out of 50 eyes were pseudophakic and received DMEK surgery only. In 9 cases a triple-DMEK was performed. BCVA increased from 0.6±0.2 logMAR preoperatively to 0.2± 0.2 logMAR at 12 months after surgery in the DMEK group (p≤0,05). After triple procedure, BCVA improved from 0.5± 0.2 logMAR preoperatively to 0.2±0.2 logMAR at 12 months (p≤0,001). CCT decreased from 701 ±132 µm preoperatively to 552 ±75 µm at 12 months after surgery (p≤0,001). ECC decreased from 2499 ±472 /sqmm preoperatively to 1683 ±303 /sqmm at 12 months after surgery (p≤0,001). IOP did not change significantly from 14 ±4 mmHg preoperatively to 12 ±1 mmHg 12 months after surgery. Four eyes presented with postoperative IOP elevation above 35 mmHg within 48 hours after surgery (8%).Three of these IOP spikes were associated with air bubble-induced mechanical iridocorneal angle closure. The most common complication was dislocation of the transplant which was seen in 10 eyes (20%). Intracameral air was used to re-position those grafts(12 Rebubblings, 24%). Primary graft failure was noted in two eyes (4%).
With appropriate experience with other forms of endothelial keratoplasty conversion to the DMEK procedure is safe and effective, with little complications. A more extensive follow-up is required to evaluate whether the initial loss of endothelial cells and outcome improves with further experience.
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