Marina Rodríguez-Calvo-de-Mora1, Ruth Quilendrino1, Lisanne Ham2, Vasilios S Liarakos1, Korine van Dijk1, Lamis Baydoun1, Isabel Dapena1, Silke Oellerich3, Gerrit R J Melles4. 1. Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands. 2. Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands. 3. Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands. 4. Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands. Electronic address: oellerich@niios.com.
Abstract
PURPOSE: To evaluate the clinical outcome of 500 consecutive cases after Descemet's membrane endothelial keratoplasty (DMEK) and the effect of technique standardization. DESIGN: Prospective, interventional case series at a tertiary referral center. PARTICIPANTS: A total of 500 eyes of 393 patients who underwent DMEK for Fuchs' endothelial corneal dystrophy, bullous keratopathy, or previous corneal transplant failure. METHODS: Best-corrected visual acuity (BCVA), endothelial cell density (ECD), pachymetry, and intraoperative and postoperative complications were evaluated before and 1, 3, and 6 months after DMEK. MAIN OUTCOME MEASURES: Comparison between 2 groups (group I: cases 1-250, outcome of "early surgeries" during transition to technique standardization; group II: cases 251-500, outcome of "late surgeries" after technique standardization). RESULTS: At 6 months, 75% of eyes reached a BCVA of ≥20/25 (≥0.8), 41% of eyes achieved ≥20/20 (≥1.0), and 13% of eyes achieved ≥20/18 (≥1.2) (n=418) when excluding eyes with ocular comorbidities (n=57). When including all available eyes at 6 months (n=475), 66% of eyes reached a BCVA of ≥20/25 (≥0.8), and 36% of eyes achieved ≥20/20 (≥1.0). Mean ECD decreased by 37% (±18%) to 1600 (±490) cells/mm2 (n=447) at 6 months (P<0.001). Postoperative pachymetry averaged 525 (±46) μm compared with 667 (±92) μm preoperatively (P<0.001). None of these parameters differed among the 2 groups (P>0.05). (Partial) graft detachment presented in 79 eyes (15.8%), and 26 eyes (5.2%) required a secondary surgery within the first 6 months (re-bubbling in 15, secondary keratoplasty in 11). With technique standardization, the postoperative complication rate decreased from 23.2% to 10% (P<0.001) and the rate of secondary surgeries decreased from 6.8% to 3.6% (P=0.10). CONCLUSIONS: In comparison with earlier endothelial keratoplasty techniques, DMEK may consistently give higher visual outcomes and faster visual rehabilitation. When used for the extended spectrum of endothelial pathologies, DMEK proved feasible with a relatively low risk of complications. Technique standardization may have contributed to a lower graft detachment rate and a relatively low secondary intervention rate. As such, DMEK may become the first choice of treatment in corneal endothelial disease.
PURPOSE: To evaluate the clinical outcome of 500 consecutive cases after Descemet's membrane endothelial keratoplasty (DMEK) and the effect of technique standardization. DESIGN: Prospective, interventional case series at a tertiary referral center. PARTICIPANTS: A total of 500 eyes of 393 patients who underwent DMEK for Fuchs' endothelial corneal dystrophy, bullous keratopathy, or previous corneal transplant failure. METHODS: Best-corrected visual acuity (BCVA), endothelial cell density (ECD), pachymetry, and intraoperative and postoperative complications were evaluated before and 1, 3, and 6 months after DMEK. MAIN OUTCOME MEASURES: Comparison between 2 groups (group I: cases 1-250, outcome of "early surgeries" during transition to technique standardization; group II: cases 251-500, outcome of "late surgeries" after technique standardization). RESULTS: At 6 months, 75% of eyes reached a BCVA of ≥20/25 (≥0.8), 41% of eyes achieved ≥20/20 (≥1.0), and 13% of eyes achieved ≥20/18 (≥1.2) (n=418) when excluding eyes with ocular comorbidities (n=57). When including all available eyes at 6 months (n=475), 66% of eyes reached a BCVA of ≥20/25 (≥0.8), and 36% of eyes achieved ≥20/20 (≥1.0). Mean ECD decreased by 37% (±18%) to 1600 (±490) cells/mm2 (n=447) at 6 months (P<0.001). Postoperative pachymetry averaged 525 (±46) μm compared with 667 (±92) μm preoperatively (P<0.001). None of these parameters differed among the 2 groups (P>0.05). (Partial) graft detachment presented in 79 eyes (15.8%), and 26 eyes (5.2%) required a secondary surgery within the first 6 months (re-bubbling in 15, secondary keratoplasty in 11). With technique standardization, the postoperative complication rate decreased from 23.2% to 10% (P<0.001) and the rate of secondary surgeries decreased from 6.8% to 3.6% (P=0.10). CONCLUSIONS: In comparison with earlier endothelial keratoplasty techniques, DMEK may consistently give higher visual outcomes and faster visual rehabilitation. When used for the extended spectrum of endothelial pathologies, DMEK proved feasible with a relatively low risk of complications. Technique standardization may have contributed to a lower graft detachment rate and a relatively low secondary intervention rate. As such, DMEK may become the first choice of treatment in corneal endothelial disease.
Authors: Jonathan H Lass; Beth Ann Benetz; Sanjay V Patel; Loretta B Szczotka-Flynn; Robert O'Brien; Allison R Ayala; Maureen G Maguire; Yassine J Daoud; Mark A Greiner; Sadeer B Hannush; W Barry Lee; Thomas F Mauger; Harry J Menegay; Mark D Mifflin; Michael B Raizman; Jennifer Rose-Nussbaumer; Robert L Schultze; Gregory A Schmidt; Alan Sugar; Mark A Terry; David D Verdier Journal: JAMA Ophthalmol Date: 2019-02-01 Impact factor: 7.389