Surgeons starting to perform Descemet membrane endothelial keratoplasty (DMEK) should be informed about the learning curve and experience of others. OBJECTIVE To document the clinical outcome of standardized "no-touch" DMEK and its complications during the learning curves of experienced surgeons. DESIGN, SETTING, AND PARTICIPANTS Retrospective multicenter study. A total of 431 eyes from 401 patients with Fuchs endothelial dystrophy (68.2%) and bullous keratopathy (31.8%) underwent DMEK performed by 18 surgeons in 11 countries. EXPOSURES Descemet membrane endothelial keratoplasty. MAIN OUTCOMES AND MEASURES Best-corrected visual acuity (BCVA), endothelial cell density, and intraoperative and postoperative complications. RESULTS Of 275 eyes available for BCVA pooled analysis, BCVA improved in 258 eyes (93.8%), remained unchanged in 12 (4.4%), and deteriorated in 5 (1.8%). Two hundred seventeen eyes (78.9%) reached a BCVA of at least 20/40 (Ն0.5), 117 (42.5%) at least 20/25 (Ն0.8), and 61 (22.2%) at least 20/20 (Ն1.0). Eyes with at least 6 months of follow-up (n = 176) reached similar BCVA outcomes. Mean (SD) decrease in endothelial cell density at 6 months was 47% (20%) (n = 133 [P = .02]). Intraoperative complications were rare, including difficulties in inserting, unfolding, or positioning of the graft (1.2%) and intraoperative hemorrhage (0.5%). The main postoperative complication was graft detachment (34.6%); 20.4% underwent a single rebubbling procedure, occasionally requiring a second (2.6%) and a third rebubbling (0.7%), and 17.6% underwent a second keratoplasty.CONCLUSIONS AND RELEVANCE Our multicenter study showed that the standardized no-touch DMEK technique was feasible in most hands. The main challenges for surgeons starting to perform the procedure may be (1) to decide whether graft preparation is outsourced or performed during surgery, (2) to limit the number of graft detachments and secondary procedures, and (3) to obtain organ cultured donor corneal tissue.

Nine cases of hemispheric retinal branch vein occlusion (HRBVO) are discussed retrospectively after identification from among 94 cases of branch vein occlusion. The high incidence of simple chronic glaucoma (close to that found in central vein occlusion cases), the presence of vein-vein disc collaterals and the visual prognosis make it important to distinguish HRBVO cases from other branch vein occlusions.

PurposePresent a new technique to perform a deep anterior lamellar keratoplasty (DALK) that could be an alternative to the “Big Bubble” or the Melles technique.ObservationsThe case concerns a 48 years old man who presents superficial corneal leukoma in the left eye secondary to ocular trauma 14 years ago. Sclero-DALK is performed under general anesthesia obtaining an excellent visual and refractive result.Conclusions and ImportanceSclero-DALK is a novelty in surgical treatment of corneal surface opacities. It offers the same advantages than conventional DALK since it is also a non-penetrating extraocular technique. Better final visual acuities are expected with this technique in comparision with PK and the conventional DALK because less residual stroma can be remained since we acces directly to the predescemetic space.

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