June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Fuchs endothelial corneal dystrophy and epithelial basement membrane dystrophy - DMEK alone or combined with debridement of the corneal epithelium?
Author Affiliations & Notes
  • Victoria Elisabeth Birgit Zeisberg
    Ophthalmology, Universitatsklinikum Erlangen, Erlangen, Bayern, Germany
  • Julia M. Weller
    Ophthalmology, Universitatsklinikum Erlangen, Erlangen, Bayern, Germany
  • Theofilos Tourtas
    Ophthalmology, Universitatsklinikum Erlangen, Erlangen, Bayern, Germany
  • Friedrich E. Kruse
    Ophthalmology, Universitatsklinikum Erlangen, Erlangen, Bayern, Germany
  • Footnotes
    Commercial Relationships   Victoria Zeisberg None; Julia Weller None; Theofilos Tourtas None; Friedrich Kruse None
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 4792. doi:
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      Victoria Elisabeth Birgit Zeisberg, Julia M. Weller, Theofilos Tourtas, Friedrich E. Kruse; Fuchs endothelial corneal dystrophy and epithelial basement membrane dystrophy - DMEK alone or combined with debridement of the corneal epithelium?. Invest. Ophthalmol. Vis. Sci. 2023;64(8):4792.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The purpose of this retrospective study was to compare the outcome of patients with Fuchs endothelial corneal dystrophy (FECD) and concomitant epithelial basement dystrophy (EBMD) after DMEK with or without epithelial debridement to help surgeons to select patients with both dystrophies undergoing DMEK who will benefit from additional epithelial removal.

Methods : A retrospective chart review of 4770 DMEK surgeries performed between 2013 and 2020 revealed 74 patients (51 female and 23 male) aged 47- 81 years (mean 67.31± 8.6) who also suffered from EBMD. Of the 74 patients 9 recieved additional debridement. The age-matched (mean age 68 ± 9.8) control group contained 41 patients (31 female, 10 male) with FECD without epithelial changes. The parameters analyzed in this study included best corrected visual acuity (BCVA), anterior densitometry (AD), higher order aberrations of the corneal of the surface (HOA) as well as surface regularity index (SRI) and surface asymmetry index (SAI).

Results : Patients with and without debridement experienced a statistically significant improvement of BCVA as well as AD which did not differ from controls (n.s.). The SRI significantly improved in patients without (0.75 ± 0.38; p=0.001) and with epithelial removal (p=0.002) but showed no significant improvement (0.61 ± 0.35; p=0.097) in the controls. Similar findings were obtained regarding HOAs of the corneal surface without (0.27 ± 0.11; p=0.000) and with epithelial debridement (0.21 ± 0.07; p=0.008).

Conclusions : The most prominent finding was that all patients with EBMD experienced a significant improvement due to DMEK surgery not only in relationship to the posterior surface of the cornea but also of the anterior surface. In line with earlier investigations by Rudolf and coworkers the anterior surface of the cornea remained basically unchanged after DMEK in patients without EBMD while the quality of the posterior surface improved. In contrast patients with EBMD experienced an improvement of the anterior exemplified by topography, SRI as well as HOAs of the corneal surfae. Regarding HOAs this criterion was the only one that showed a statistically significant difference between patients with and without debridement .

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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