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DMEK: learning curve and 6 month results of a French series
Session Title: Cornea surgical I
Session Date/Time: Tuesday 08/10/2013 | 08:00-10:30
Paper Time: 09:18
Venue: Forum (Ground Floor)
First Author: : A.Saad FRANCE
Co Author(s): : E. Guilbert D. Gatinel Nuijts
To describe the results of the first twenty DMEK cases and compare the outcome of the first 5 cases with the rest of the series.
Rothschild Foundation, Paris, France
Prospective, observational case series of the first 20 eyes of 19 patients undergoing a DMEK surgery for corneal decompensation at the authors institution. The endothelio-Descemet graft was manually prepared in the operating room and was inserted in the receiver Anterior Chamber (AC) using a dedicated single use injector after removal of the recipient Descemet membrane. The AC was completely filled with air for 30 minutes, afterward air was reduced to 70%. All the surgeries were recorded. Clinical outcome were obtained at 1,3 and 6 months. Surgery and graft preparation time as well as clinical outcomes were compared between the first 5 cases and the rest of the group.
Among the 2 groups clinical outcomes were similar, with 70% of cases achieving a BCVA of 0.1 LogMar or better and an average ECD of 1420 cells/mm2, at 6 months. Mean graft preparation time was 48 +/- 20 minutes in the first 5 cases and 31 +/- 4 minutes in the rest of the group and the difference was statistically significant (p<0.05). Mean surgical time was 62 +/- 16 mn in the first 5 cases and 44 +/- 18 mn in the rest of the group and the difference was statistically significant (p<0.05). In the first 5 cases we were not able to complete the donor preparation because of a central tear in one case and the graft was wrongly oriented (endothelial cells facing the posterior stroma) in another case. In the remaining 15 cases, the graft preparation failed in one case and the graft was wrongly positioned in one case.
The learning curve in DMEK did not correlate with clinical outcome (BCVA and ECD), but rather to the presence of a functional graft. However, surgery time and the graft preparation time decline with the surgeon experience.