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Ophthalmology. 2015 Mar;122(3):464-70. doi: 10.1016/j.ophtha.2014.09.004. Epub 2014 Oct 22.

Clinical outcome of 500 consecutive cases undergoing Descemet's membrane endothelial keratoplasty.

Author information

1
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands.
2
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands.
3
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands.
4
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands. Electronic address: oellerich@niios.com.

Abstract

PURPOSE:

To evaluate the clinical outcome of 500 consecutive cases after Descemet's membrane endothelial keratoplasty (DMEK) and the effect of technique standardization.

DESIGN:

Prospective, interventional case series at a tertiary referral center.

PARTICIPANTS:

A total of 500 eyes of 393 patients who underwent DMEK for Fuchs' endothelial corneal dystrophy, bullous keratopathy, or previous corneal transplant failure.

METHODS:

Best-corrected visual acuity (BCVA), endothelial cell density (ECD), pachymetry, and intraoperative and postoperative complications were evaluated before and 1, 3, and 6 months after DMEK.

MAIN OUTCOME MEASURES:

Comparison between 2 groups (group I: cases 1-250, outcome of "early surgeries" during transition to technique standardization; group II: cases 251-500, outcome of "late surgeries" after technique standardization).

RESULTS:

At 6 months, 75% of eyes reached a BCVA of ≥20/25 (≥0.8), 41% of eyes achieved ≥20/20 (≥1.0), and 13% of eyes achieved ≥20/18 (≥1.2) (n=418) when excluding eyes with ocular comorbidities (n=57). When including all available eyes at 6 months (n=475), 66% of eyes reached a BCVA of ≥20/25 (≥0.8), and 36% of eyes achieved ≥20/20 (≥1.0). Mean ECD decreased by 37% (±18%) to 1600 (±490) cells/mm2 (n=447) at 6 months (P<0.001). Postoperative pachymetry averaged 525 (±46) μm compared with 667 (±92) μm preoperatively (P<0.001). None of these parameters differed among the 2 groups (P>0.05). (Partial) graft detachment presented in 79 eyes (15.8%), and 26 eyes (5.2%) required a secondary surgery within the first 6 months (re-bubbling in 15, secondary keratoplasty in 11). With technique standardization, the postoperative complication rate decreased from 23.2% to 10% (P<0.001) and the rate of secondary surgeries decreased from 6.8% to 3.6% (P=0.10).

CONCLUSIONS:

In comparison with earlier endothelial keratoplasty techniques, DMEK may consistently give higher visual outcomes and faster visual rehabilitation. When used for the extended spectrum of endothelial pathologies, DMEK proved feasible with a relatively low risk of complications. Technique standardization may have contributed to a lower graft detachment rate and a relatively low secondary intervention rate. As such, DMEK may become the first choice of treatment in corneal endothelial disease.

PMID:
25439596
DOI:
10.1016/j.ophtha.2014.09.004
[Indexed for MEDLINE]

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