Descemet membrane endothelial keratoplasty (DMEK): clinical results of precut versus surgeon-cut grafts

Abstract

Purpose This study aims to investigate possible differences in clinical outcomes between precut and surgeon-cut grafts for Descemet membrane endothelial keratoplasty (DMEK). Methods 142 consecutive patients who underwent DMEK were included in the study. 44 patients received precut tissues, and 98 patients received surgeon-cut tissues. Precut grafts were allocated to the patient by the German Society for Tissue Transplantation if available. We compared the outcomes of both groups for changes in visual acuity, central corneal thickness, endothelial cell density, re-bubbling rate, and graft failure rate. Results Patients who received precut tissues experienced similar increase in visual acuity (median change 0.4 logMAR) and decrease of corneal swelling (median change 132 μm) compared with those who received surgeon-cut tissues (median VA change 0.3 logMAR, p = 0.55, CCT change 118 μm, p = 0.63). There was no statistical difference in endothelial cell density (1436 vs. 1569 cells/mm2, p = 0.37), re-bubbling (32% vs. 35%, p = 0.85), and graft failure rate (5% vs. 1%, p = 0.23). No primary graft failure occurred in the group of precut grafts. Conclusion Both methods lead to comparable results for visual acuity, corneal deswelling, endothelial cell density, and re-bubbling rate. A previously described higher graft failure rate for precut tissues could not be confirmed in our study. Thus, we do not see medical reasons against the use of precut tissues. There are several advantages of precut DMEK tissues over surgeon-cut tissues, especially the prevention of graft loss during preparation in the operating theater.

A machine learning approach to explore predictors of graft detachment following posterior lamellar keratoplasty: a nationwide registry study

“…Regarding these factors, our analyses are inconclusive. Regarding preparation techniques, our results are consistent with previous studies that found no difference between pre-cut and surgeon-cut tissues 13 , 15 . Graft marking was associated with an increased risk of detachment in the Lasso model only.…”

A Functional and Immunologic Point of View on Corneal Endothelial Transplantation: A Systematic Review and Meta-Analysis

“…DMEK is considered the most up to date EK procedure choice in Western countries [ 3 ], although the collection of inserted Descemet’s endothelium lamella (14–20 μm) requires a long learning curve [ 53 , 54 ]. Immune rejection is drastically cut down to 1% (C.I.…”

“…No significant changes have been reported, but a reduction trend in rejection risk has been unveiled by our analysis (Figure 3). DMEK is considered the most up to date EK procedure choice in Western countries [3], although the collection of inserted Descemet's endothelium lamella (14-20 µm) requires a long learning curve [53,54]. Immune rejection is drastically cut down to 1% (C.I.…”

“…In fact, a critical selection bias may limit comparison among these procedures. In actual clinical practice, surgeons suggest DMEK mostly in eyes with normal ocular anatomy and good visual potential while they suggest UT-DSAEK in eyes with poor surgical view, complex ocular anatomy, and lower visual potential [ 53 ].…”