Visual Outcome of Descemet Membrane Endothelial Keratoplasty during the Learning Curve in Initial Fifty Cases

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.

Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand

“… 29 In general, a DMEK graft is clinically stained with 0.06% trypan blue for about 30 seconds to 5 minutes before transplantation. 23 , 31 , 41 This usually allows the surgeon to clearly visualize the donor tissue in the recipient anterior chamber and exhibits no endothelial toxicity. Nevertheless, in this study, a 3-minute stain with 0.1% trypan blue was chosen because our patients had a dark iris and most of them had long-standing corneal edema, further compromising intraoperative graft visualization.…”

Effects of Combined Cataract Surgery on Outcomes of Descemet's Membrane Endothelial Keratoplasty: A Systematic Review and Meta-Analysis

“…It is important to note that of the 17 studies that compared both approaches, four studies did not specify the preoperative lens status of DMEK eyes ( 39 , 41 – 43 ), two studies reported a mix of pseudophakic and phakic DMEK surgeries but did not analyze them separately ( 37 , 40 ). Similarly, Godin et al ( 34 ) have reported a mix of pseudophakic and phakic DMEK surgeries and the group analyzed them independently.…”

Ability of routinely collected clinical factors to predict good visual results after primary Descemet membrane endothelial keratoplasty: a cohort study

“…One was also a multivariate analysis [ 12 ]. The fourth study examined the first 50 DMEK patients in a facility and showed that older donor age (> 50 years) associated with better 3-month BCVA [ 8 ]. This may reflect the inexperience of the operator and the fact that older DMEK grafts scroll less tightly and are therefore easier to manipulate than younger grafts [ 51 , 52 ].…”

“…All have some limitations: one included patients with corneas at both the early and end stages of FECD (i.e. the preoperative VAs ranged from very low to almost normal [ 5 ]); others examined variables that are not measured during the standard preoperative ophthalmological assessment before DMEK (anterior surface irregularities [ 3 , 21 ] and anterior corneal haze [ 25 , 26 ]); and many examined a mixture of indications rather than FECD only [ 5 – 8 , 10 – 14 , 16 , 18 – 20 , 22 , 23 ], which are driven by different pathophysiologies [ 27 – 29 ] and can influence the final best corrected VA (BCVA) [ 12 , 18 , 20 ]. Most importantly, none systematically assessed a large array of routinely recorded pre/perioperative demographic and clinical factors for their ability to predict final BCVA after DMEK in FECD patients with explanatory multivariate analysis.…”