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Multicenter trial on Descemet"s membrane endothelial keratoplasty (DMEK): first case series of 18 surgeons
Session Title: Cornea surgical I
Session Date/Time: Tuesday 08/10/2013 | 08:00-10:30
Paper Time: 09:24
Venue: Forum (Ground Floor)
First Author: : L.Baydoun THE NETHERLANDS
Co Author(s): : C. Monnereau G. Melles
To document the clinical outcome of standardized no-touch Descemet membrane endothelial keratoplasty (DMEK) and its complications during the learning curve of experienced surgeons.
Retrospective multicenter interventional study of a total of 431 eyes of 401 patients. DMEK was performed for Fuchs endothelial dystrophy (68%), bullous keratopathy (28%) or other indications (4%) by 18 different surgeons in 11 countries. Best corrected visual acuity (BCVA), endothelial cell density and intra- and postoperative complications were recorded.
Overall, BCVA improved in 258 eyes (94%), remained unchanged in 12 eyes (4%), and deteriorated in 5 eyes (2%). Visual acuity data up to 6 months were pooled (n=275) and showed that 217 eyes (79%) reached a BCVA of ?20/40 (?0.5), 117 eyes (43%) ?20/25 (?0.8), and 61 (22%) ?20/20 (?1.0). Eyes with a follow-up of exactly 6 months (n=176) reached similar BCVA outcomes: 144 eyes (82%) ?20/40 (?0.5), 77 (44%) ?20/25 (?0.8), and 33 (19%) ?20/20 (?1.0). Average decrease in endothelial cell density at 6 months was 47% (n=133). Intraoperative complications were rare, including difficulties in inserting, unfolding or positioning of the graft (1%) and intraoperative hemorrhage (0.5%). The main postoperative complication was graft detachment (35%); 20% underwent a single rebubbling procedure, occasionally requiring a second or third rebubbling (3% and 1%, respectively), and 18% a secondary keratoplasty.
Our multicenter trial showed that the standardized DMEK technique was feasible in most hands. The main challenges for surgeons starting out with 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. When successful, the visual outcome after DMEK may be relatively independent of the techniques learning curve.