Abstract
This study was performed to evaluate the clinical outcomes of the first fifty patients who underwent Descemet membrane endothelial keratoplasty (DMEK) during the 3-month postoperative period and to describe the challenges encountered during the learning curve. In this retrospective study, we reviewed the charts of patients who underwent DMEK. All information regarding patient demographics, indication for surgery, preoperative and postoperative visual acuity at 3 months, donor age, and complications encountered intraoperatively and postoperatively was recorded. Donor endothelial cell count at the time of surgery and during the 3-month follow-up was noted. Data were analyzed using SPSS version 17. Fifty eyes of 49 patients were included in the study with majority being female patients (male : female = 2 : 3). Mean age of patients was 56.8 ± 11.4 years with the age range of 22–78 years. The common indications for DMEK were pseudophakic bullous keratopathy –57.1%, Fuchs endothelial dystrophy-34.7%, failed grafts-6.1% (Descemet stripping endothelial keratoplasty (DSEK) and failed penetrating keratoplasty), and others. Preoperative best spectacle-corrected visual acuity was <20/400 in 88% cases. Postoperative best spectacle-corrected visual acuity at 3 months was >20/63 in 41.8% of the cases, and 93% had visual acuity of 20/200 or better. Donor size was 8 mm, and average donor endothelial cell count (ECC) was 2919 ± 253 cells/mm2. Average ECC at 3 months postoperatively was 1750 ± 664 cells/mm2, which showed a 40% decrease in ECC. The most common encountered complication was graft detachment, which occurred in 16% cases for which rebubbling was done. Regular follow-up and timely identification of graft detachment may prevent the need for retransplantation.
Highlights
Introduction e concept ofDescemet membrane endothelial keratoplasty (DMEK) was introduced by Melles in 2002 [1], and the first successful case of DMEK was reported in 2006 for Fuchs endothelial dystrophy by Melles et al [2, 3]
We reviewed the charts of patients who underwent DMEK
The donor cornea can be effectively utilized for two lamellar surgeries: deep anterior lamellar keratoplasty (DALK) and DMEK in areas where there is still a scarcity of donor corneas [14]
Summary
Introduction e concept ofDescemet membrane endothelial keratoplasty (DMEK) was introduced by Melles in 2002 [1], and the first successful case of DMEK was reported in 2006 for Fuchs endothelial dystrophy by Melles et al [2, 3]. Outcomes of DMEK are superior compared to Descemet stripping endothelial keratoplasty (DSEK) in terms of providing better visual acuity, more predictable postoperative refractive outcomes, and reduced rate of immune reactions [12, 15, 16]. The learning curve is quite steep and is a major hindrance for cornea surgeons to transition from penetrating keratoplasty (PK) or DSEK to DMEK [7, 17]. E most common postoperative complications following DMEK surgery is graft detachment which can be managed by rebubbling [7, 20, 21]. Is study was conducted with the aim to describe the clinical outcome of DMEK cases at 3 months performed by a single surgeon and to describe the difficulties and complications encountered during the initial learning curve The learning curve is quite steep and is a major hindrance for cornea surgeons to transition from penetrating keratoplasty (PK) or DSEK to DMEK [7, 17]. e major challenges in DMEK involve handling the thin tissue during donor preparation while avoiding tears of the graft, minimizing the loss of endothelial cells during preparation, and intraoperatively unrolling the Journal of Ophthalmology graft in the proper orientation within the anterior chamber [4, 18, 19]. e most common postoperative complications following DMEK surgery is graft detachment which can be managed by rebubbling [7, 20, 21]. is study was conducted with the aim to describe the clinical outcome of DMEK cases at 3 months performed by a single surgeon and to describe the difficulties and complications encountered during the initial learning curve
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