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Descemet’s membrane endothelial keratoplasty (DMEK): a comparison of visual outcomes in complex and non-complex cases

Poster Details

First Author: F.Musa UK

Co Author(s):    B. Shevade                    

Abstract Details

Purpose:

To prospectively evaluate and report the comparative clinical outcomes between complex and non-complex eyes undergoing DMEK. Complex cases were defined as eyes that had prior intraocular surgery other than routine phaco-emulsification cataract surgery. This included cases that had undergone glaucoma filtration surgery, scleral fixated intraocular lenses, vitrectomy and penetrating keratoplasty.

Setting:

Single surgeon consecutive cases series at a large United Kingdom National Health Service Hospital.

Methods:

Demographic details, pre-existing ocular conditions, intra-operative and post-operative complications were noted. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refractive error and central corneal thickness (CCT) were evaluated prior to DMEK and 1, 3, 6, 12 and 18 months after surgery.

Results:

Data was obtained for 27 eyes of 23 patients; of which 11 eyes were categorised complex cases. There were no graft failures in the non-complex group and three graft failures in the complex group. No patients in the non-complex group lost BCVA; two patients in the complex group experienced a loss in BCVA (graft failure and retinal detachment). Post-operative BCVA ranged from hand movements to 6/9 in complex eyes and 6/18 (amblyopic eye) to 6/5 in non-complex eyes. There was an average reduction in CCT of 20% in complex eyes and 22% in non-complex eyes.

Conclusions:

DMEK is a challenging surgical procedure however the improvement in vision and rapidity of recovery makes it an attractive option in cases of endothelial failure. Success rates have improved with standardization of techniques and increasing experience. In eyes with significant ocular co-morbidities success rates are reduced, however substantial improvement in vision is possible in carefully selected cases. Despite obtaining excellent corneal clarity, there are often other factors such as glaucoma and retinal disorders than may limit visual outcomes in complex cases.

Financial Disclosure:

NONE

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