Comparison of triple-DMEK to pseudophakic-DMEK: A cohort study of 95 eyes

Abstract

Previous comparative studies show that triple Descemet membrane endothelial keratoplasty (DMEK) (i.e. phacoemulsification followed immediately by DMEK) has either equivalent or better visual outcomes than DMEK in pseudophakic patients. To resolve this discrepancy, a retrospective cohort study was conducted. All consecutive patients with Fuchs Endothelial Corneal Dystrophy who underwent triple or pseudophakic DMEK in 2015–2019 in a tertiary-care hospital (France) and were followed for >12 months were compared in terms of best spectacle-corrected visual acuity (BSCVA), final refractive outcomes, and endothelial-cell loss at 12 months as well as rebubbling rates. The triple-DMEK (40 eyes, 34 patients) and pseudophakic-DMEK (55 eyes, 43 patients) groups were similar in terms of age and other baseline variables. They also did not differ in final BSCVA (both 0.03 logMAR), final endothelial-cell loss (54% vs. 48%), or astigmatism (-1.25 vs. -1 D). At 12 months, triple-DMEK associated with significantly smaller residual hyperopia (0.75 vs. 1 D; p = 0.04) and spherical equivalence (0 vs. 0.5 D; p = 0.02). Triple-DMEK also tended to associate with more frequent rebubbling (40% vs. 24%, p = 0.09). In conclusion, while triple-DMEK and pseudophakic-DMEK achieved similar visual acuity improvement, triple-DMEK was superior in terms of final sphere and spherical refraction but also tended to have higher complication rates.

Combined or sequential DMEK in cases of cataract and Fuchs endothelial corneal dystrophy—A systematic review and meta‐analysis

“…After screening 947 articles, 5 articles satisfied our inclusion criteria and were included in our meta‐analysis (Arslan et al, 2019; Fajardo‐Sanchez & de Benito‐Llopis, 2021; Hussien et al, 2021; Semler‐Collery et al, 2022; Shahnazaryan et al, 2020). All studies were NRSs comparing outcomes in eyes that underwent combined DMEK or sequential DMEK.…”

“…The domains due to which the overall risk of bias was considered serious were bias due to missing data and bias in selection of the reported results. Specifically, Semler‐Collery et al excluded patients from statistical analysis who had persistent corneal oedema 3 months after transplantation (Semler‐Collery et al, 2022) and Hussien et al excluded primary graft failure cases from postoperative corneal thickness as well as from postoperative ECD statistical analysis (Hussien et al, 2021).…”

“…While graft detachment is the most common postoperative complication after DMEK, (Parekh et al, 2018) the rebubbling rate was also investigated in our meta‐analysis and no evidence of a difference between the two groups was found. The only study with which these results are not perfectly matched is the retrospective cohort study by (Semler‐Collery et al, 2022), in which in 95 eyes with FECD that underwent combined or sequential DMEK, eyes that received combined DMEK tended to be associated with higher rebubbling rates than sequential DMEK (40% vs. 24%; p = 0.09). According to the authors (Semler‐Collery et al, 2022), one possible explanation could be related to the use of viscoelastic substances (OVD), as the sequential procedure is generally performed under air without the use of viscoelastic, which is usually only utilized in combined DMEK procedures.…”

“…The only study with which these results are not perfectly matched is the retrospective cohort study by (Semler‐Collery et al, 2022), in which in 95 eyes with FECD that underwent combined or sequential DMEK, eyes that received combined DMEK tended to be associated with higher rebubbling rates than sequential DMEK (40% vs. 24%; p = 0.09). According to the authors (Semler‐Collery et al, 2022), one possible explanation could be related to the use of viscoelastic substances (OVD), as the sequential procedure is generally performed under air without the use of viscoelastic, which is usually only utilized in combined DMEK procedures. There is evidence that graft detachment and consequently the rebubbling rate can be influenced by the use of OVD in combined DMEK (Anshu et al, 2012; Chaurasia et al, 2014; Woo et al, 2019).…”

Postoperative, but not preoperative, central corneal thickness correlates with the postoperative visual outcomes of Descemet membrane endothelial keratoplasty

“…In approximately half of the surgeries, the main incision was sutured with one point of Nylon 10.0 that was secondarily buried and removed 1 month later. In the case of triple-DMEK, phacoemulsification was performed before DMEK as described previously [23]. Intracameral steroids were not applied.…”