Session Title: Cornea
Session Date/Time: Sunday 05/02/2012 | 08:30-11:00
Paper Time: 09:29
Venue: Hall 1
First Author: : R.Yeh NETHERLANDS
Co Author(s): : V. LIARAKOS M. DIRISAMER I. DAPENA L. HAM K. VAN DIJK G. MELLES
Purpose:
To evaluate Descemet membrane endothelial keratoplasty (DMEK) for the management of corneal endothelial disorders.
Setting:
Non–randomized, prospective clinical study, at a tertiary referral center. Netherlands Institute for Innovative Ocular Surgery, Rotterdam.
Methods:
DMEK was performed in 200 patients with Fuchs endothelial dystrophy or bullous keratopathy. Best corrected visual acuity (BCVA), refractive outcome and stability, and endothelial cell density (ECD) were evaluated at one, three, and six months postoperatively, and intra- and postoperative complications were documented. RESULTS At six months, 94% reached a BCVA equal or better than 20/40 (≥0.5), 77% equal or better than 20/25 (≥0.8), 47% equal or better than 20/20 (≥1.0), and 16% equal or better than 20/17 (≥1.2) (n=159). The pre- to six months postoperative spherical equivalent showed a +0.38D (±1.2D) hyperopic shift (P<0.001) that correlated with a decrease in pachymetry (n=143) (P=0.047). Two-thirds of all eyes showed refractive stability at three months. Donor ECD showed a decrease from 2560 (±186) cells/mm2 before, to 1690 (±520) cells/mm2 at six months after surgery (n=173) (P<0.001). Graft detachment was the main complication and occurred in 18 eyes (9%). Recipient Descemet membrane remnants were present in 12 eyes (6%). Secondary glaucoma was seen in eight eyes (4%), four of which showed air-bubble dislocation behind the iris. In two out of 33 phakic eyes (6%), a secondary cataract developed requiring phacoemulsification.
Conclusions:
DMEK may offer complete visual rehabilitation within 1 to 6 months after surgery in the majority of cases. Similar to earlier keratoplasty techniques, DMEK may be associated with a one-third decrease in donor ECD in the early postoperative phase. The incidence of (partial) graft detachment stabilized at about 5%, but could be further reduced by patient selection and/or technique modification.
Financial Disclosure:
... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented
