Corneal grafts and cataracts: comparing penetrating keratoplasties vs DSEK vs DMEK

Session Details

Session Title: Cataract Surgery Outcomes and Complications

Session Date/Time: Monday 07/09/2015 | 14:30-16:00

Paper Time: 15:06

Venue: Room 17

First Author: : G.Baikoff FRANCE

Co Author(s): :    C. Aubert                    

Abstract Details

Purpose:

Corneal edema keratoplasty surgery can be necessary when deciding on cataract surgery in cornea Guttata eyes or for corneal complications following cataract surgery . The authors compared 3 techniques of corneal grafting currently available for corneal edema: Penetrating keratoplasty (PKP), Descemet stripped endothelial keratoplasty (DSEK), and Descemet membrane endothelial keratoplasty (DMEK)

Setting:

Clinique Monticelli, 88 rue du Cdt Rolland, 13008 Marseille, France

Methods:

60 eyes having undergone graft surgery by the same surgeon (GB) for pre or post-cataract extraction corneal edema were studied. The techniques used were PKP, DSEK, and DMEK. We compared 2 kinds of indications: edema associated with cataract surgery and edemas as a secondary complication following cataract surgery. This represented 6 series of 10 eyes each; In order to eliminate the surgeon's learning curve effect we chose to include the more recent DSEKs and DMEKs (only 3 months follow-up) whereas the PKPs were analyzed after 6 to 7 months follow-up.

Results:

In each series, we analyzed postoperative best corrected distant visual acuity (BCDVA), best corrected near visual acuity (BCNVA), astigmatism and endothelial cell density (ECD). It is clear that the best mean visual results were obtained with DMEKs (BCVA 0,74), followed by PKPs (0,48) and last of all DSEKs (0,3). Mean astigmatism is lower (less than 2D) with DMEKs and DSEKs than with PKPs (5,7 D) whatever the surgical indication. However, after 6 months follow-up, the ECD is higher after PKPs (2150/2030 C/mm²) than after DMEKs and DSEKs (1350/1834 C/mm²)

Conclusions:

DMEK surgery appears to be the best technique concerning fast functional recovery and quality of vision. Endothelial cell loss appears higher following DMEKs and DSEKs than PKPs. However, one must keep in mind that even if the endothelial alteration is greater, recovery is so fast and exceptional that for the patient, repeating DMEKs rather than PKPs is not an immediate concern.

Financial Interest:

NONE