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Anne-Claude MADKAUD, Sarah Stoebener, DA COSTA Marie, Zaidi Mohamed, Louis Lhuillier, Nadia Ouamara, christophe goetz, Jean-Marc Perone; Simplified DMEK Technique : Description and Clinical Outcomes about 106 Eyes. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6295.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose of this study is to describe a simplified technique of Descemet membrane endothelial keratoplasty (DMEK) and to compare results at 6 months with reference techniques (in terms of visual acuity, endothelial cell loss and success rate).
A prospective and mono-centric study was conducted from March 2015 to November 2018, on a series of 106 eyes of 94 patients with mainly Fuchs dystrophy indication (90%). The graft preparation was performed intraoperatively and consisted of the following steps : a 8 mm microtrepan Hanna trephination, a direct dissection of the Descemet membrane using a single-use monofilament tying forceps and a stromal face marking of the graft during dissection, before placement in an injectable system with glass cannula. The end of the intervention was identical to the other techniques. Pre- and post-operative visual acuity (VA) at 1, 3 and 6 months, success rate, endothelial cell loss (ECL) at 6 months and possible complications were analyzed.
Mean pre-operative VA was equivalent to 0.72 logmar (± 0.40), 0.54 logmar (± 0.55) at M1, 0.28 logmar (± 0.39) at M3 and 0.27 logmar (± 0.46) at M6 with a gain in VA at 6 months of 0.45 logmar. The ECL at 6 months was equivalent to 44% (2575 cells/mm^2 preop vs 1435 cells/mm^2 postop at M6). The success rate was 89%, with a rebulbing rate of 51% (53 cases) and a 4% Irvine Gass syndrome rate (4 cases), for an average operative time including graft preparation of 36 minutes (± 10).
This original simplified DMEK grafting technique allows a safe orientation of the graft under an operating microscope, thus reducing graft failures by inverting the graft. This technique is simpler, safer and more effective, with an excellent success rate, good visual acuity recovery and has not shown excessive loss of endothelial cells compared to the other described DMEK techniques.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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