Multicenter study on Descemet's membrane endothelial keratoplasty (DMEK)

Session Details

Session Title: Cornea
Session Date/Time: Friday 09/02/2018 | 08:30-10:00
Paper Time: 08:30
Venue: Annex A

First Author: J.Peraza-Nieves SPAIN
Co Author(s): S. Oellerich  L. Baydoun  P. Binder  G. Melles        

Abstract Details

Purpose:

To document the current surgical approaches, clinical outcomes and complications of standardized ‘no-touch’ Descemet membrane endothelial keratoplasty (DMEK) in eyes operated by 55 starting or experienced DMEK surgeons.

Setting:

Retrospective, multicenter, interventional, cohort study.

Methods:

In a total of 2,485 eyes undergoing DMEK for Fuchs endothelial corneal dystrophy (74%), bullous keratopathy (17%), transplant failure (8%), or other indications (1%), ‘no-touch’ DMEK was performed by 55 surgeons in 23 countries (International DMEK study group). Main outcome measures were best corrected visual acuity (BCVA), endothelial cell density (ECD), and intra- and postoperative complications.

Results:

BCVA improved in 90.5% of eyes, remained unchanged in 4.6%, and deteriorated in 4.9% (n=1,936). At 6 months, 75.4% of eyes reached a BCVA of ≥20/40, 45.4% of ≥20/25, and 25.8% of ≥20/20 and mean ECD was 40(±19)% (n=1,272, P<0.05). Intraoperative complications were reported for 9.4% of eyes, while (partial) graft detachment was the main postoperative complication (27.4%). Surgeons that had performed ≥100 DMEK surgeries had lower intra- and postoperative complication rates than surgeons with ≤25 DMEK surgeries (P<0.05), but BCVA and ECD outcomes did not differ between beginning and experienced DMEK surgeons (P=.07 and P=.53, respectively).

Conclusions:

Our multicenter study shows that standardized ‘no-touch’ DMEK is feasible for surgeons in various clinical and surgical settings with good clinical outcomes in terms of visual acuity and ECD decrease. After an arbitrary learning curve of about 25 cases, intra- and postoperative complication rates may decrease. Notably, surgeons with a higher annual caseload may pass faster through their learning curve than surgeons performing their first surgeries over an extended period.

Financial Disclosure:

research is funded, fully or partially, by a competing company