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Br J Ophthalmol. 2018 Oct;102(10):1425-1430. doi: 10.1136/bjophthalmol-2017-311398. Epub 2018 Jan 17.

Quarter-Descemet membrane endothelial keratoplasty (Quarter-DMEK) for Fuchs endothelial corneal dystrophy: 6 months clinical outcome.

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Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.
Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands.
Amnitrans EyeBank Rotterdam, Rotterdam, The Netherlands.



To assess the clinical outcome of the first series of Quarter-Descemet membrane endothelial keratoplasty (Quarter-DMEK), a potential hybrid technique between 'descemetorhexis only' and conventional, circular DMEK.


Prospective interventional case series at a tertiary referral centre. Twelve eyes of 12 patients with central Fuchs endothelial corneal dystrophy underwent Quarter-DMEK, that is, transplantation of one quadrant of a full-diameter DMEK graft, and were evaluated for best-corrected visual acuity (BCVA), endothelial cell density (ECD) and complications up to 6 months postoperatively.


At 6 months postoperatively, all eyes reached a BCVA of ≥20/40 (≥0.5), 11/12 (92%) of ≥20/25 (≥0.8) and 6/12 (50%) of ≥20/20 (≥1.0). Mean central ECD decreased from 2867 (±161) cells/mm2 before to 1255 (±514) cells/mm2 at 1 month, 1058 (±455) cells/mm2 at 3 months and 968 (±427) cells/mm2 at 6 months after surgery. Rebubbling was performed in 4/12 eyes (33%) within the first two months.


Quarter-DMEK may be a feasible procedure that allows for visual outcomes similar to conventional, circular DMEK. The relatively large drop in ECD within the first month may have resulted from more extensive endothelial cell migration and/or measurement error (at the graft edges). If longer-term outcomes would resemble those of conventional DMEK, Quarter-DMEK may potentially quadruple the availability of endothelial grafts.


cell migration; descemet membrane endothelial keratoplasty; endothelial cell density; hemi-DMEK; pachymetry; quarter-DMEK; visual acuity

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