Abstract
Purpose :
The aim of the study is to compare 2 types of surgical procedure in DMEK (Descemet Membrane Endothelial Keratoplasty) surgeries: sequential or combined procedure.
Methods :
This was a prospective monocentric multivariate study about 106 patients, 32 of them underwent combined surgery (group1) and 74 non-combined surgery (group2) between March 2014 and November 2018. Our primary endpoint was loss of endothelial cell density at 6 months and 1year, evaluated by specular microscopy. The secondary endpoint was postoperative visual acuity at 1, 3 and 6 and 12 months. Furthermore we studied grafts detachments and surgery rate success.
Results :
Preoperative VA was similar in both groups (0,63 logmar ±0,39 group 1 versus 0,74 logmar ± 0,39 in group 2, p = 0,2). The study showed that after 1months, VA results appeared similar in both groups (0,46±0,45 in group1 versus 0,55±0,56 in the second group2, p = 0,42). At 3months the VA results were closed in each group: 0,25 ± 0,34 group 1 versus 0,24 ± 0,34 group 2, p = 0,94. 6months post-surgical VA in group 1 was identical with group 2: (0,20 logmar ± 0,30 versus 0,18 logmar ±0,32, p = 0,7). After 1 year, VA measure appeared close each other in both groups (0,08 logmar ± 0,20 group 1 and 0,12 ± 0,30, p = 0,63). Preoperative mean endothelial density was close each other in the two groups: (2556 ± 248 group1 versus 2584 ± 179, p = 0,52). Mean endothelial cell density at 6 months in group 1 was not different from group 2: (1260 ± 390 versus 1481,33 ± 435,85, p = 0,1). After 1 year of following, mesures revealed a endothelial density equivalent in both groups: (1190 ± 504 group 1 versus 1324,62 ± 399,63, p = 0,37). In the first group, 28 surgical operations (88%) succeeded with a living and functional graft versus 57 patients (77%) in group 2, showing a difference of 11% (p = 0,29). The % rate of grafts detachments was equivalent to 59% in the group1 versus 48% in group2 (p = 0,3).
Conclusions :
The two procedures were equivalent considering mid-term endothelial density and visual acuity. No surgery seemed to be better than the other regarding the graft detachment risk. Triple DMEK procedure appears to be an effective strategy for a quick visual rehabilitation and seems to offer the same benefits as sequential procedure.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.