Descemet's membrane endothelial keratoplasty for treatment of patients with corneal endothelial decompensation

Abstract

Objective: To evaluate the clinical outcomes of Descemet's membrane endothelial keratoplasty (DMEK) for treatment of patients with corneal endothelial decompensation in China. Methods: Interventional case series. Ten patients (10 eyes) with the diagnosis of corneal endothelial decompensation received DMEK during July 2016 and September 2016 in Zhongshan Ophthalmic Center. Descemet's membrane of the donor tissue was carefully stripped from the underlying stroma manually and cut with a 7.75- or 8.0-mm-diameter donor punch. After stained with 0.06% typan blue, the donor disc loaded on an inserter was gently inserted into the anterior chamber of the recipient. When the rolled graft was unfolded, air was carefully injected into the anterior chamber underneath the graft, so that the graft attached to the stroma of the recipient. All patients were followed up for 3-6 months. The best spectacle corrected visual acuity, the status of donor disc, corneal thickness and corneal endothelial cell density were documented and analyzed. Results: At 1 day after surgery, 1 donor disc presented a rolled edge, and repeated DMEK surgery was performed for this patient. The remaining 9 donor discs presented in place well. At 1 month after surgery, 7 donor discs were found to well attach to the back surface of the recipient stroma with normal corneal posterior surface using anterior segment optical coherence tomography. The average corneal thickness reduced to (620±67) μm from preoperative (680±78.3) μm (t=2.677, P=0.025). At 3 months after surgery, 6 patients achieved clear corneas with best spectacle corrected visual acuity ranging from 0.4 to 0.8. The endothelial cell density was 1 342.3±436.5 (872 to 1 933) cells/mm(2) in the patients with clear corneas. The average corneal thickness reduced to (612±70) μm (t=2.971, P=0.016). Conclusions: DMEK could improve visual acuity for corneal endothelial decompensation, but there were more technical difficulties in Chinese eyes. (Chin J Ophthalmol, 2017, 53: 534-539).