Standardization of the Descemet membrane endothelial keratoplasty technique: Outcomes of the first 450 consecutive cases

Abstract

ObjectivesTo evaluate the clinical outcome of the first 450 consecutive cases after Descemet membrane endothelial keratoplasty (DMEK), as well as the effect of standardization of the technique. Material and methodsComparison between 3 groups: Group I: (cases 1–125), as the extended learning curve; Group II: (cases 126–250), transition to technique standardization; Group III: (cases 251–450), surgery with standardized technique. Best corrected visual acuity, endothelial cell density, pachymetry and intra- and postoperative complications were evaluated before, and 1, 3 and 6 months after DMEK. ResultsAt 6 months after surgery, 79% of eyes reached a best corrected visual acuity of ≥0.8 and 43% ≥1.0. Mean preoperative endothelial cell density was 2530±220cells/mm2 and 1613±495 at 6 months after surgery. Mean pachymetry measured 668±92μm and 526±46μm pre- and (6 months) post-operatively, respectively. There were no significant differences in best corrected visual acuity, endothelial cell density and pachymetry between the 3 groups (p>0.05). Graft detachment presented in 17.3% of the eyes. The detachment rate declined from 24% to 12%, and the rate of secondary surgeries from 9.6% to 3.5%, from group I to III respectively. ConclusionsVisual outcomes and endothelial cell density after DMEK are independent of the technique standardization. However, technique standardization may have contributed to a lower graft detachment rate and a relatively low number of secondary interventions required. As such, DMEK may become the first choice of treatment in corneal endothelial disease.