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Marshall Jin Huang, Steven Kane, Deepinder Dhaliwal; DWEK vs DMEK for Treatment of Fuchs’ Endothelial Corneal Dystrophy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2904. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
We compared the visual outcomes and associated morbidity of patients with Fuchs’ endothelial corneal dystrophy who were treated with either Descemet membrane endothelial keratoplasty (DMEK) or descemetorhexis without endothelial keratoplasty (DWEK).
We present a retrospective chart review of 27 consecutive patients with Fuchs’ dystrophy who were treated by a single surgeon at the University of Pittsburgh with either DMEK (n=15) or descemetorhexis without endothelial keratoplasty (DWEK) (n=12). Descemetorhexis was performed by removing the central 4mm of the diseased Descemet membrane at the end of phacoemulsification for cataract surgery and allowing the cornea to heal by secondary intention. All patients had mild to moderate disease with no bullae and relatively clear peripheral corneas. We excluded all patients with retinal pathologies that may have limited vision. Visual acuity was measured with pinhole and Snellen chart, and then converted to LogMAR for analysis.
93% of patients who underwent DMEK and 100% of patients who underwent DWEK achieved 20/40 vision when measured by pinhole (p=1.00). The average post-op pinhole visual acuity was 20/25-1 (LogMAR 0.16±0.09) for DMEK patients and 20/30+1 (LogMAR 0.13±0.10) for DWEK patients (p=0.44). The average time to 20/40 vision for DMEK was 2.2±2.8 weeks compared to 7.1±2.7 weeks for DWEK (p<0.01). In our DMEK group, 8 (53%) patients had adverse events, including increased intraocular pressure (n=7), anterior chamber inflammation (n=1), and graft non-adherence (n=1), with 2 patients (13%) requiring a rebubbling procedure. Our DWEK group had no adverse events (p<0.01).
Descemetorhexis without endothelial keratoplasty (DWEK) effectively treats mild to moderate cases of central Fuchs’ dystrophy with equivalent visual outcomes to the current standard of care, DMEK. Although recovery time may be longer, DWEK performed at the time of cataract surgery reduces adverse events and additional procedures, and eliminated the need for donor corneal tissue.
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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