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Learning Descemet's membrane endothelial keratoplasty (DMEK): is prior experience with descemet stripping endothelial keratoplasty (DSEK) essential?

Poster Details

First Author: M.Ziaei UK

Co Author(s):    M. Bhogal   B. Allan                 

Abstract Details

Purpose:

This study aims to report the initial DMEK outcomes of two trainee surgeons operating under supervision with no significant prior experience with DSEK (less than 10 cases).

Setting:

Cornea and External Diseases Service, Moorfields Eye Hospital, London, UK.

Methods:

Prospective single center study. 40 eyes of 35 patients with endothelial failure undergoing DMEK or combined phaco-DMEK. Unicameral eyes, eyes with previous glaucoma shunt surgery, and vitrectomised eyes were excluded. 8-8.5mm diameter grafts were prepared using the peripheral scoring technique and injected into the eye using a glass cannula. A cohesive ophthalmic viscoelastic device was utilised in 95% of cases for Descemetorhexis. All patients had a complete anterior chamber air fill for 1 hour postoperatively before air fill adjustment to prevent pupil block. The rates of intraoperative complications, peripheral detachment, repeat air fill, and primary graft failure were recorded.

Results:

Graft preparation was successful in all cases with no loss of tissue. Surgery was uneventful in 90% of cases. One case required intraoperative re-staining of the DMEK graft whilst another case was complicated by significant iris bleeding from the peripheral iridotomy. Partial detachments were seen in (10/40) 25% of cases. 12.5% of eyes required a single rebubbling procedure with air which resulted in complete graft attachment in all cases. Primary graft failure occurred in 5% of cases.

Conclusions:

Our clinical outcomes are in keeping with that reported in the literature from a multicenter study evaluating the initial DMEK case series of 18 experienced corneal surgeons. Lack of experience with older endothelial keratoplasty techniques such as DSEK is therefore not a significant barrier towards learning DMEK using a standardized technique and case selection criteria.

Financial Disclosure:

NONE

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