Intraoperative Optimisation And Outcomes Of Endothelium-In Preloaded Vs Surgeon-Loaded Dmeks In Asian Eyes
Published 2025 - 43rd Congress of the ESCRS
Reference: PO928 | Type: Poster | DOI: 10.82333/aveg-ce37
Authors: Keen-Chong Chau* 1 , Ezekiel Ze Ken Cheong 2 , Qiu Ying Wong 3 , Marcus Ang 4
1SNEC,Singapore,Singapore, 2Duke NUS,Singapore,Singapore, 3SERI,Singapore,Singapore, 4Cornea and Refractive Surgery,SNEC,Singapore,Singapore
Purpose
To describe intraoperative optimisation subsequent outcomes of imported preloaded grafts versus surgeon-loaded grafts in Descemet membrane endothelial keratoplasty (DMEK) in Asian eyes.
Setting
Intra-operative optimisation and pre-loading of grafts during DMEK surgery may help surgeons with the steep learning curve. However, there are few direct comparative studies highlighting intra-operative and early post-operative complications between preloaded versus surgeon-loaded DMEKs.
Methods
We performed 60 consecutive preloaded DMEKs and surgeon-loaded DMEKs, for the indications of Fuchs’ endothelial cell dystrophy (FECD) and pseudophakic bullous keratopathy (PBK). All cases of preloaded and surgeon-loaded DMEKs were by a single surgeon in the Singapore National Eye Centre and utilized endothelium-in pull-through cartridges (CORONET DMEK Endoglide; Network Medical Products, United Kingdom). All cases received intraoperative optimisation i.e. local anaesthesia with optimal sedation, intraoperative vitreous pressure and intraocular pressure control. Main outcome measures were intra-operative time and complications. Secondary outcome measures were endothelial cell loss and complications up to 3 months post-operatively.
Results
Preloaded DMEKs had significantly shorter intra-operative times (26.2 min vs 39.5 min; P < 0.001) than surgeon-loaded DMEKs, but were associated with increased intra-operative risk of conversion to standard injector-DMEK (15% vs 0%; P = 0.033). However, there was no increase in overall intra-operative complications (40% vs 22.5%; P = 0.156), post-operative complications (40% vs 30%; P = 0.439) and rebubbling rate (5% vs 5%; P > 0.999). Visual outcomes and endothelial cell loss (ECL) were not significantly different in both groups.
Conclusions
In our Asian study cohort of pull-through DMEKs, endothelium-in preloaded DMEKs were significantly faster than surgeon-loaded DMEKs and had comparable clinical outcomes. Preloading endothelium-in as opposed to endothelium-out could confer similar outcomes versus surgeon-loaded DMEKs.