Evaluating Dmek Performance And Results In The Early Training Phase Of Cornea Fellows

To evaluate the performance and outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) during the early training phase of cornea fellows, assessing surgical efficiency, complication rates, and postoperative results.

A tertiary eye care centre, Bhubaneswar, India.

A retrospective analysis of 65 DMEK cases performed by 8 cornea fellows was conducted over a period of 6 years. All the fellows had previous experience of performing atleast 40 PK, 15 DSAEK, and 5 DMEK graft preparations under experienced supervision. Variables analysed included surgical duration, ease of graft unfolding, intraoperative and postoperative complications, graft detachment rates, and visual outcomes. Statistical comparisons were made between fellows with ≤180 days and >180 days of training, and between those with ≤8 and >8 DMEK cases performed. Independent t-tests and chi-square analyses were used to assess differences.

The mean surgical duration was 38.9 ± 18.5 minutes, with fellows having >180 days of training demonstrating a shorter duration (p=0.123). Graft detachment occurred in 33.8% of cases, with no significant difference between experience groups (p=0.653). Visual acuity (CDVA) improved postoperatively, with fellows having more experience achieving better outcomes (p=0.031). Graft failure was observed in 26.2% of cases, while rebubbling was required in 32.3%. There was no statistically significant association between intraoperative complications and training duration (p=0.821).

Early-phase cornea fellows demonstrate a learning curve in DMEK, with surgical efficiency and visual outcomes improving with experience. However, complication rates such as graft detachment and pupillary block remain considerable. Further structured training and mentorship may enhance outcomes and reduce complications in early DMEK training.