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Rachel Epstein, Parag Majmudar, Randy Epstein, Jonathan Rubenstein; Demystifying DMEK: A comparison of donor preparation. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1294.
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© ARVO (1962-2015); The Authors (2016-present)
Descemet Membrane Endothelial Keratoplasty (DMEK) has been demonstrated to be a superior endothelial keratoplasty technique resulting in better visual outcomes with lower risk of graft rejection, albeit with a steeper surgical learning curve. Pre-cut eye bank prepared tissue has eased some of the challenge inherent to the procedure, however no standard for donor tissue preparation prevails. Accordingly, we utilized a retrospective comparative chart review to compare the outcomes of a single trephination ("single") versus "double" trephination ("double") donor preparation employed for DMEK when performed both alone as well as in combination with phacoemulsification and intraocular lens implantation (IOL).
We conducted a retrospective comparative chart review of 125 DMEK procedures ("single" and "double" trephination) performed by 3 surgeons with tissue provided by the Eversight Illinois Eye Bank. Outcome measures included pre-operative and post-operative (acquired from ≥ 6-month follow-up) best corrected visual acuity (BCVA), endothelial cell density (ECD), and pachymetry (μm), as well as reported episodes of graft rejection and/or graft failure.
125 consecutive eyes were evaluated, 49 cases were performed with a "double" donor preparation, 76 cases performed with "single" donor preparation. Mean logMar pre-operative BCVA of the "single" group (n=49) was 0.788 and 0.709 in the "double" group (n=76). Mean post-operative BCVA of the "single" group 0.47 and 0.44 in the "double" group; there was no statistically significant difference between these groups pre- (p=0.58, CI (95%) -0.36 - 0.20) or post-operatively (p=0.7884, CI (95%) -0.309 - 0.235). Mean ECD (cells/mm2) pre-operatively was 2721 in the "single" group and 1198 post-operatively, a 44% decrease in cells; mean ECD pre -operatively was 2761 in the "double" group and 1281 post-operatively, representing in a 49% decrease in cells. Mean pachymetry (μm) was 695 in the "single" group pre-operatively and 569 post- operatively and 670 in the "double" group pre-operatively and 552 post-operatively. There was a 14% primary graft failure rate and a 9.5% re-bubble rate in the "double" group versus a 15% primary graft failure rate and 23% re-bubble rate in the "single" group.
Single trephination is a viable modification for Eye Bank donor preparation, which simplifies this potentially challenging technique.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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