Descemet's membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival.
OBJECTIVE
To describe Descemet's membrane endothelial keratoplasty (DMEK) techniques, perioperative challenges, management, and visual and refractive outcomes.


METHODS
Prospective, multicenter, consecutive case series.


METHODS
Sixty eyes of 56 patients with Fuchs' endothelial dystrophy, pseudophakic bullous keratopathy, or failed previous graft.


METHODS
Descemet's membrane (DM) and endothelium were stripped from donor corneas submerged in corneal storage solution in a corneal viewing chamber. Donor DM diameters were 8.5 or 9.0 mm. The central 7 mm of DM was stripped from the recipient cornea. After staining with trypan blue to improve visualization, donor DM was inserted through a 2.8-mm incision. Descemet's membrane endothelial keratoplasty was performed alone (n = 48) or was combined with phacoemulsification and lens implantation (n = 11), pars plana vitrectomy (n = 2), or both.


METHODS
Best spectacle-corrected visual acuity (BSCVA), manifest refraction, and endothelial cell density.


RESULTS
Median BSCVA was 20/30 at 1 month (range, 20/20-20/60), improving from 20/50 (range, 20/25-hand movements) before DMEK, excluding 4 eyes (7%) with preexisting ocular pathologic features that limited visual potential. At 3 months, 26% had 20/20 vision, 63% saw 20/25 or better, and 94% saw 20/40 or better. Refractive cylinder remained unchanged at 0.9 diopters (D; P = 0.93), and a hyperopic shift of 0.49+/-0.63 D (P = 0.0091) was noted in DMEK single procedures. Endothelial cell loss was 30%+/-20% at 3 months and 32%+/-20% in 38 eyes that reached the 6-month examination. Median pachymetry decreased from 660 mum before surgery to 530 mum. Descemet's membrane stripped successfully from 60 of 72 donor corneas; 6 were converted successfully to Descemet's stripping automated endothelial keratoplasty (DSAEK) and 6 (8%) were discarded. Only 1 graft detached completely, but air was reinjected in 38 eyes (63%), mainly for partial detachments. Five DMEK corneas (8%) failed to clear and were replaced successfully with DMEK or DSAEK. All remained clear at last follow-up.


CONCLUSIONS
Compared with DSAEK, DMEK provided a significantly higher rate of 20/20 and 20/25 vision, with comparable endothelial cell loss. Descemet's membrane endothelial keratoplasty restored physiologic pachymetry, but donor preparation and attachment currently are more challenging than with DSAEK.
Price
Marianne O
MO
Cornea Research Foundation of America, Indianapolis, Indiana 46260, USA. marianneprice@cornea.org
Giebel
Arthur W
AW
Fairchild
Kelly M
KM
Price
Francis W
FW
D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D017690:Cell Transplantation; D016039:Corneal Transplantation; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology*; D014019:Tissue Donors; D014792:Visual Acuity / Q000502:physiology*