Functional Results After Descemet's Membrane Endothelial Keratoplasty (Dmek) In A Real-World Practice: Two Years Of Experience

To evaluate the functional results after performing a DMEK surgery in our centre.

Specifications

To analyse the impact of surgery on endothelial cells and pachymetry.

To study refractive results.

To analyse the efficacy of prophylactic iridotomy to prevent postoperative pupillary block and in relation to IOP.

To study the rate of intra and post-surgical complications.

To study the rebubbling rate.

To study the rate and need for reintervention.

To compare the functional results between a single procedure (DMEK) and a triple procedure (Phacoemulsification + Intraocular lens implantation + DMEK) at the same time.

To compare functional results in patients with and without ophthalmological comorbidities of the operated eye.

A retrospective case series study is presented in which the medical records of patients operated on for DMEK between January 1, 2020 and January 1, 2023 at the Hospital Universitari Germans Trias i Pujol de Badalona (n=45) were analysed. The data has been analysed baseline, a month, 3 month, 6 month and a year after the surgery.

The information analysed was completely anonymized and the study adheres to the principles of the Declaration of Helsinki.

Epidemiological, clinical, surgical and donor variables of operated patients (age, gender, diagnosis for which DMEK was indicated, ophthalmological comorbidities, operated eye, visual acuity/VA according to Early treatment diabetic retinopathy study charts/ETDRS protocol, sphere, cylinder, cylinder axis, pachymetry, endothelial cell counts, intraocular pressure/PIO, association or not with cataract surgery, complications and their management, age and graft cell count) have been analysed.

Inclusion criteria

All patients operated on for DMEK in our centre between January 1, 2020 and January 1, 2023.

Exclusion criteria

Any patient whose medical record data cannot be accessed.

Graft survival measured 96.1% at 1 year.

Best spectacle-corrected visual acuity (BSCVA) in primary transplants according to ETDRS protocol was baseline 55.8, improving to 66.8 at a month, 74.7 at three months, 74.4 at six month and 73.5 letters in a year.

IOP baseline was 17.5mmHg, 16.7 at a month and 17.7 at a year without significant differences.

Baseline optical refraction was 0.885 -1.31 67.7, at a month 0.813 -1.74 67.5, at 3 month 1.40 -1.24 66.6, at 6 month and with a final refraction 0.856 -1.23 79.1

Pachymetry was 687 baselines, 627 at a month, 597 in three month, 632 in 6 month and 543µm in a year

Endothelial cells count for mm2 was 742 baseline, 666 in a month, 1307 in three month, 1086 in six month and in a year 1326.

In our centre most patients operated for DMEK were older people, women, and diagnosed with Fuchs' dystrophy.

We can see an improvement in VA after surgery, gaining around 20 letters according ETDRS protocol and maintaining this VA until a year.

The sphere has not been influenced by surgery, while refractive astigmatism has decreased until reaching a lower cylinder than preoperative one.

Regarding the IOP, there have been no important changes.

Regarding pachymetry, we found an improvement in postoperative thickness.

Finally, about the endothelial count, we have a clear gain compared to preoperative count and that remain stable after one year.

We conclude that DMEK have improved VA, refraction, pachymetry and endothelial cell count in our patients.