Claire Monnereau1, Ruth Quilendrino2, Isabel Dapena3, Vasilios S Liarakos2, Jose F Alfonso4, Francisco Arnalich-Montiel5, Matthias Böhnke6, Nicolas Cesário Pereira7, Martin Dirisamer8, John Parker9, Konstantinos Droutsas10, Gerd Geerling11, Georg Gerten12, Hassan Hashemi13, Akira Kobayashi14, Miguel Naveiras4, Oganes Oganesyan15, Emeterio Orduña Domingo16, Siegfried Priglinger8, Pavel Stodulka17, José Torrano Silva18, Davide Venzano19, Jan Markus Vetter20, Evan Yiu21, Gerrit R J Melles3. 1. Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the Netherlands. 2. Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the Netherlands2Melles CorneaClinic Rotterdam, Rotterdam, the Netherlands. 3. Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the Netherlands2Melles CorneaClinic Rotterdam, Rotterdam, the Netherlands3Amnitrans Eyebank Rotterdam, Rotterdam, the Netherlands. 4. Instituto Oftalmológico Fernández-Vega, Universidad de Oviedo, Madrid, Spain. 5. Department of Ophthalmology, Hospital Universitario Ramon y Cajal, Madrid, Spain. 6. Augentagesklinik und Laserzentrum, Hamburg, Germany. 7. Banco de Olhos de Sorocaba, Sorocaba, Brazil. 8. Department of Ophthalmology, General Hospital Linz, Linz, Austria. 9. Callahan Eye Hospital, University of Alabama, Birmingham. 10. Department of Ophthalmology, Philipps University Marburg, Marburg, Germany. 11. Department of Ophthalmology, Heinrich-Heine-Universität Dusseldorf, Dusseldorf, Germany. 12. Augenklinik am Neumarkt, Köln, Germany. 13. NOOR Ophthalmology Research Center, NOOR Eye Hospital, Tehran, Iran. 14. Department of Ophthalmology, Kanazawa University, Kanazawa, Japan. 15. Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia. 16. La Unidad Oftalmológica Balear, Clinica Palmaplanas Palma de Mallorca, Mallorca, Spain. 17. Gemini Eye Clinic, Zlin, Czech Republic. 18. Centro Oftalmologico Sertãozinho, Sao Paulo, Brazil. 19. University Eye Clinic, Genova, Italy. 20. Cornea Bank, Mainz, Germany. 21. Tuen Mun Eye Center, Hong Kong Special Administrative Region.
Abstract
IMPORTANCE: Surgeons starting to perform Descemet membrane endothelial keratoplasty (DMEK) should be informed about the learning curve and experience of others. OBJECTIVE: To document the clinical outcome of standardized "no-touch" DMEK and its complications during the learning curves of experienced surgeons. DESIGN, SETTING, AND PARTICIPANTS: Retrospective multicenter study. A total of 431 eyes from 401 patients with Fuchs endothelial dystrophy (68.2%) and bullous keratopathy (31.8%) underwent DMEK performed by 18 surgeons in 11 countries. EXPOSURES: Descemet membrane endothelial keratoplasty. MAIN OUTCOMES AND MEASURES: Best-corrected visual acuity (BCVA), endothelial cell density, and intraoperative and postoperative complications. RESULTS: Of 275 eyes available for BCVA pooled analysis, BCVA improved in 258 eyes (93.8%), remained unchanged in 12 (4.4%), and deteriorated in 5 (1.8%). Two hundred seventeen eyes (78.9%) reached a BCVA of at least 20/40 (≥0.5), 117 (42.5%) at least 20/25 (≥0.8), and 61 (22.2%) at least 20/20 (≥1.0). Eyes with at least 6 months of follow-up (n = 176) reached similar BCVA outcomes. Mean (SD) decrease in endothelial cell density at 6 months was 47% (20%) (n = 133 [P = .02]). Intraoperative complications were rare, including difficulties in inserting, unfolding, or positioning of the graft (1.2%) and intraoperative hemorrhage (0.5%). The main postoperative complication was graft detachment (34.6%); 20.4% underwent a single rebubbling procedure, occasionally requiring a second (2.6%) and a third rebubbling (0.7%), and 17.6% underwent a second keratoplasty. CONCLUSIONS AND RELEVANCE: Our multicenter study showed that the standardized no-touch DMEK technique was feasible in most hands. The main challenges for surgeons starting to perform the procedure may be (1) to decide whether graft preparation is outsourced or performed during surgery, (2) to limit the number of graft detachments and secondary procedures, and (3) to obtain organ cultured donor corneal tissue.
IMPORTANCE: Surgeons starting to perform Descemet membrane endothelial keratoplasty (DMEK) should be informed about the learning curve and experience of others. OBJECTIVE: To document the clinical outcome of standardized "no-touch" DMEK and its complications during the learning curves of experienced surgeons. DESIGN, SETTING, AND PARTICIPANTS: Retrospective multicenter study. A total of 431 eyes from 401 patients with Fuchs endothelial dystrophy (68.2%) and bullous keratopathy (31.8%) underwent DMEK performed by 18 surgeons in 11 countries. EXPOSURES: Descemet membrane endothelial keratoplasty. MAIN OUTCOMES AND MEASURES: Best-corrected visual acuity (BCVA), endothelial cell density, and intraoperative and postoperative complications. RESULTS: Of 275 eyes available for BCVA pooled analysis, BCVA improved in 258 eyes (93.8%), remained unchanged in 12 (4.4%), and deteriorated in 5 (1.8%). Two hundred seventeen eyes (78.9%) reached a BCVA of at least 20/40 (≥0.5), 117 (42.5%) at least 20/25 (≥0.8), and 61 (22.2%) at least 20/20 (≥1.0). Eyes with at least 6 months of follow-up (n = 176) reached similar BCVA outcomes. Mean (SD) decrease in endothelial cell density at 6 months was 47% (20%) (n = 133 [P = .02]). Intraoperative complications were rare, including difficulties in inserting, unfolding, or positioning of the graft (1.2%) and intraoperative hemorrhage (0.5%). The main postoperative complication was graft detachment (34.6%); 20.4% underwent a single rebubbling procedure, occasionally requiring a second (2.6%) and a third rebubbling (0.7%), and 17.6% underwent a second keratoplasty. CONCLUSIONS AND RELEVANCE: Our multicenter study showed that the standardized no-touch DMEK technique was feasible in most hands. The main challenges for surgeons starting to perform the procedure may be (1) to decide whether graft preparation is outsourced or performed during surgery, (2) to limit the number of graft detachments and secondary procedures, and (3) to obtain organ cultured donor corneal tissue.
Authors: K Droutsas; A Lazaridis; G D Kymionis; K Chatzistefanou; M M Moschos; C Koutsandrea; W Sekundo Journal: Eye (Lond) Date: 2017-11-17 Impact factor: 3.775
Authors: Meraf A Wolle; David L DeMill; Lauren Johnson; Stephen I Lentz; Maria A Woodward; Shahzad I Mian Journal: Cornea Date: 2017-11 Impact factor: 2.651