Format

Send to

Choose Destination
See comment in PubMed Commons below
Ophthalmology. 2011 Dec;118(12):2368-73. doi: 10.1016/j.ophtha.2011.06.002. Epub 2011 Aug 27.

Descemet's membrane endothelial keratoplasty: prospective study of 1-year visual outcomes, graft survival, and endothelial cell loss.

Author information

  • 1Cornea Research Foundation of America, Indianapolis, Indiana 46260, USA.

Abstract

PURPOSE:

To report 1-year outcomes of Descemet's membrane endothelial keratoplasty (DMEK) performed at 2 centers.

DESIGN:

Prospective, consecutive, interventional series.

PARTICIPANTS:

Patients with Fuchs' endothelial dystrophy, pseudophakic bullous keratoplasty, or failed previous graft (n = 136 eyes).

INTERVENTION:

The diseased central 7 mm of Descemet's membrane (DM) was stripped from the recipient cornea and replaced with healthy DM and endothelium stripped from donor corneas through a 2.8-mm corneal incision. Descemet's membrane endothelial keratoplasty was performed alone (n = 110) or combined with either phacoemulsification and intraocular lens implantation (n = 23) or pars plana vitrectomy (n = 3).

MAIN OUTCOME MEASURES:

Best spectacle-corrected visual acuity (BSCVA), manifest refraction, and endothelial cell density.

RESULTS:

Excluding eyes with pre-existing ocular comorbidities or those lost to follow-up, mean BSCVA at 1 year was 0.07 logarithm minimum angle of resolution (logMAR) units (20/24; range, 20/15-20/40; n = 81), improving from 0.51 logMAR (20/65; range, 20/20-counting fingers); 41% of the patients achieved a BSCVA of 20/20 or better, 80% could be corrected to 20/25 or better, and 98% achieved 20/30 or better vision. A refractive hyperopic shift of +0.24 ± 1.01 diopters (D; range, -1.50 to 2.25 D) was found at 1 year, but it was not statistically significant (P = 0.08). Also, there was no significant change in the preoperative astigmatism (P = 0.17). The endothelial cell loss at 1 year was 36 ± 20% (n = 94; range, 13%-88%), with most of the loss being observed during the first 3 months after surgery: 31 ± 18% (range, 3%-77%). The DMEK graft creation could not be successfully completed in 6 cases (4.2%). All these unsuccessful attempts were among the initial 40 cases. Intracameral air was used to fix graft detachments, which usually were partial and peripheral, in 62% of the cases. Eleven grafts (8%) demonstrated primary failure and 1 eye (0.7%) had secondary failure resulting from endothelial rejection. Episodes of immunologic rejection were documented in 7 eyes (5.1%) during the first year of follow-up.

CONCLUSIONS:

Descemet's membrane endothelial keratoplasty had better visual acuity results in the first year after surgery than typically reported for other endothelial keratoplasty techniques, such as Descemet's stripping automated endothelial keratoplasty, while having less refractive changes and similar endothelial cell counts but a higher rebubbling rate.

FINANCIAL DISCLOSURE(S):

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk