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Three year outcomes of contact lens-assisted pull through technique for tri-folded Descemet's membrane endothelium keratoplasty (DMEK)

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First Author: A.Yu PHILIPPINES

Co Author(s):    A. Yu   C. Bovone   R. Spena   F. Fusco   S. Socea   M. Busin     

Abstract Details

Purpose:

To report the 3-year clinical outcomes of tri-folded, endothelium-in DMEK using a contact lens assisted bimanual pull-through delivery technique.

Setting:

Tertiary Care Referral Center (Ospedali Privati Forlì, Villa Igea)

Methods:

All consecutive eyes that underwent DMEK for endothelial decompensation of various indications between January 2015 and December 2016 were reviewed (n=153). DMEK was performed using pre-stripped donor tissue punched to an 8.25 mm diameter; and loaded into a disposable cartridge via a sterile soft contact lens scaffold, in a tri-folded, endothelium-in configuration. The graft was delivered into the anterior chamber under continuous irrigation using a bimanual pull-through technique. Complete ophthalmologic examinations were performed preoperatively and annually for 3 years after surgery. Outcome measures included best spectacle-corrected visual acuity (BSCVA), endothelial cell density(ECD), surgical time and complications rates.

Results:

At 3 years, excluding patients with ocular comorbidities, Snellen BSCVA ≥20/20, ≥ 20/25, ≥20/40 was achieved respectively in 61%, 89% and 100% of eyes. Compared to preoperative values, BSCVA improved significantly at 1 year (p=0.001) and remained stable up to 3 years postoperatively. Annual average rate of endothelial cell loss after the first year was 4.5%. Graft failure occurred in 10 eyes (6.7%) of which only 2 (1.3%) was due to immunologic rejection. Mean surgical time was 17.8 (SD=1.9) minutes.

Conclusions:

Tri-folded, endothelium-in Descemet membrane endothelial keratoplasty (DMEK) provides excellent outcomes while minimizing surgical time compared to other DMEK techniques.

Financial Disclosure:

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