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Friedrich E. Kruse, Claus Cursiefen, Bjoern O. Bachmann, Kathrin Laaser; A Standardized Technique for Descemet Membrane Endothelial Keratoplasty (DMEK): Results after 12 Months. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1632.
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© ARVO (1962-2015); The Authors (2016-present)
Descemet membrane endothelial keratoplasty (DMEK) is a new technique for the replacement of diseased corneal endothelium which can render visual results of unsurpassed quality. However, technical issues regarding tissue preparation, insertion and graft adhesion limit the use of this technique. Here we present mid term results of a novel, standardized approach to DMEK.
Donor preparation was performed by a bimanual scuba technique, donor insertion using an IOL shooter with air bubbles allowing for graft orientation in 185 patients. BCVA, endothelial cell density, anterior chamber OCT and pachymetry were quantified in 80 patients at 3, 6 and 12 months.
Donor preparation was uneventful in 181/184 procedures but not possible in 3 donors due to central adhesions. With the novel shooter/air bubble technique orientation was preserved in 95% of surgeries. After surgery 69 patients developed partial, peripheral graft detachment necessitating rebubbling. Nonimmunological graft failure occurred in 14/184 grafts. 8 failed DMEKs were among the first 20 surgeries performed during the early learning curve of the procedure. Mean visual acuity (logMAR) improved from 0,68 + 0,48 preoperatively to 0,15 + 0,14 12 months after DMEK. Endothelial cell density decreased by 45 % after 12 months. Pachymetry decreased from 680 + 110 µm preoperatively to 518 + 35 µm 12 months postoperatively.
Important modifications of the original technique allow significant improvements and enhance reproducibility of the surgery. In our hands DMEK rendered unsurpassed functional and morphological outcome which is stable at least 12 months after surgery.
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