Abstract
To evaluate the outcomes of the hybrid technique of posterior lamellar keratoplasty (Descemets' membrane endothelial keratoplasty with stromal rim, DMEK-S) in eyes with multiple ocular pathologies. A retrospective case control study of the consecutive group of all eyes with combined ocular pathologies which underwent DMEK-S keratoplasty. We evaluated the number of pre- and post-operative complications; uncorrected distance visual acuity (UDVA); corrected distance visual acuity (CDVA) and endothelial cell density (ECD). The first group (Group 1 - 100 eyes) was compared to a control group of eyes (Group 2 - 145 eyes) without combined ocular pathologies, which were operated throughout the same time period. Comparisons were made in the 12th month of the follow-up. Both the UDVA and the CDVA statistical values 12 months after the surgery were significantly better in Group 2. ECD was comparable in both groups. The number of complications during surgery was considerably higher in Group 1, where a certain type of complication occurred in 15 eyes (15%), while in Group 2 this complication occurred only in 9 eyes (6.2%). In Group 1 a slightly higher number of rebubbling cases (52% vs. 48.3%) occurred, as well as more than twice as many cases of primary graft failure (34% vs. 15.7%) compared to Group 2. DMEK-S - hybrid endothelial transplantation in complicated eyes in the evaluated group of patients led to a noticeable improvement of visual acuity. When compared to surgeries in uncomplicated eyes, DMEK-S results in a higher rate of postoperative complications, especially graft detachment and primary failure.
Highlights
There are currently several types of lamellar endothelial transplantation available for patients with endothelial dysfunction, such as bullous keratophaty, Fuchs endothelial dystrophy, posterior polymorphous endothelial dystrophy, iridocorneal endothelial syndrome, and corneal endothelial failure after perforating keratoplasty (PK) or lamellar keratoplasty.The two most frequently used techniques of lamellar endothelial transplantation are DSAEK (Descemet stripping automated endothelial keratoplasty) where the lamella consists of deep stromal layers, Descemet's membrane (DM), and endothelium[1]; and DMEK (Descemets membrane endothelial keratoplasty) where the lamella consists only of DM and endothelium[2,3].Since 2007 the most commonly used method within our department has been the Descemets membrane endothelial keratoplasty with stromal rim (DMEK-S) method, where a hybrid lamella is transplanted
Hybrid lamella consists of DM and endothelium in its central part, without the presence of stroma, while in peripheral areas there is a rim of deep stromal layers
We evaluated the number of intra- and post-operative complications; uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) in decimal values; endothelial cell density (ECD) in cc/mm[2]
Summary
The two most frequently used techniques of lamellar endothelial transplantation are DSAEK (Descemet stripping automated endothelial keratoplasty) where the lamella consists of deep stromal layers, Descemet's membrane (DM), and endothelium[1]; and DMEK (Descemets membrane endothelial keratoplasty) where the lamella consists only of DM and endothelium[2,3]. Since 2007 the most commonly used method within our department has been the DMEK-S method, where a hybrid lamella is transplanted. Hybrid lamella consists of DM and endothelium in its central part, without the presence of stroma, while in peripheral areas there is a rim of deep stromal layers. The hybrid lamella theoretically combines the advantages of both previously mentioned techniques, i.e. a relatively easy manipulation (DSAEK)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
