David Shahnazaryan1, Aida Hajjar Sese1, Emma J Hollick2. 1. King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK. 2. King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK. Electronic address: emma.hollick@nhs.net.
Abstract
PURPOSE: This study compared the outcomes of Descemet's membrane endothelial keratoplasty (DMEK) in pseudophakic patients with the outcomes after DMEK combined with cataract surgery (triple-DMEK) in patients with Fuchs endothelial dystrophy (FED). DESIGN: Retrospective, single-institution, interventional, consecutive case series. METHODS: Outcomes of 114 DMEKs in patients with FED and a minimum of 1-year follow-up were reviewed; 34 eyes (29 patients) were pseudophakic and underwent DMEK-only and 80 eyes (56 patients) underwent triple-DMEK. Main outcome measures included endothelial cell loss (ECL), best-corrected visual acuity (BCVA), central corneal thickness (CCT) and complications. RESULTS: One-month ECL was 25% (±16) and 35% (±15) in DMEK-only and triple-DMEK groups respectively. One-year ECL was 33% (±13) and 41% (±16) in DMEK-only and triple-DMEK groups. There was statistically significantly less ECL after DMEK-only than after triple-DMEK at both 1 month (95% confidence interval [CI], 1.67 to 15.02; P = .016) and 1 year (95% CI, 1.06 to 14.07; P = .034). CCT was significantly lower after DMEK-only than triple-DMEK at 1 month, but not at 1 year. BCVA was excellent and similar in the two groups. There were no cases of graft failure, while graft rejection (8.8% vs 8.75%; P = 0.50) and rebubbling rates (2.9% vs 2.5%; P = 0.44) were similar in the two groups. CONCLUSIONS: Both DMEK-only and triple-DMEK groups have very low rebubbling rates and good visual outcomes, however combined triple-DMEK procedure resulted in significantly greater loss of endothelial cells compared to DMEK-only surgery at both 1 month and 1 year.
PURPOSE: This study compared the outcomes of Descemet's membrane endothelial keratoplasty (DMEK) in pseudophakic patients with the outcomes after DMEK combined with cataract surgery (triple-DMEK) in patients with Fuchs endothelial dystrophy (FED). DESIGN: Retrospective, single-institution, interventional, consecutive case series. METHODS: Outcomes of 114 DMEKs in patients with FED and a minimum of 1-year follow-up were reviewed; 34 eyes (29 patients) were pseudophakic and underwent DMEK-only and 80 eyes (56 patients) underwent triple-DMEK. Main outcome measures included endothelial cell loss (ECL), best-corrected visual acuity (BCVA), central corneal thickness (CCT) and complications. RESULTS: One-month ECL was 25% (±16) and 35% (±15) in DMEK-only and triple-DMEK groups respectively. One-year ECL was 33% (±13) and 41% (±16) in DMEK-only and triple-DMEK groups. There was statistically significantly less ECL after DMEK-only than after triple-DMEK at both 1 month (95% confidence interval [CI], 1.67 to 15.02; P = .016) and 1 year (95% CI, 1.06 to 14.07; P = .034). CCT was significantly lower after DMEK-only than triple-DMEK at 1 month, but not at 1 year. BCVA was excellent and similar in the two groups. There were no cases of graft failure, while graft rejection (8.8% vs 8.75%; P = 0.50) and rebubbling rates (2.9% vs 2.5%; P = 0.44) were similar in the two groups. CONCLUSIONS: Both DMEK-only and triple-DMEK groups have very low rebubbling rates and good visual outcomes, however combined triple-DMEK procedure resulted in significantly greater loss of endothelial cells compared to DMEK-only surgery at both 1 month and 1 year.
Authors: Axelle Semler-Collery; Florian Bloch; George Hayek; Christophe Goetz; Jean Marc Perone Journal: PLoS One Date: 2022-05-12 Impact factor: 3.240