title: Prospective study of visual outcomes and endothelial survival with Descemet membrane automated endothelial keratoplasty.
abstract: OBJECTIVE
  To evaluate vision and endothelial cell survival in an initial Descemet membrane automated endothelial keratoplasty (DMAEK) series.
  
  
  METHODS
  This was a prospective nonrandomized study of an initial consecutive series of 40 DMAEK cases, performed with or without concomitant phacoemulsification and intraocular lens implantation. The graft was dissected with a microkeratome. A central 6- to 7-mm big bubble was created to separate endothelium from stroma, and the overlying stroma was excised. The graft was cut to 8.5- to 9.5-mm diameter and inserted with a pull through technique. Eyes were treated for Fuchs endothelial dystrophy, secondary corneal decompensation, or previous failed endothelial transplant. Best spectacle-corrected visual acuity, manifest refraction, pachymetry, and endothelial cell density were assessed.
  
  
  RESULTS
  Median best spectacle-corrected visual acuity was 20/30 at 1 month (range: 20/15-20/50), improved from 20/40 (range: 20/25-20/400) preoperatively, excluding 7 eyes (18%) with significant retinal pathology. Rates of 20/20, 20/25, 20/30, and 20/40 vision were 25%, 71%, 89%, and 100%, respectively, at 3 months and 48%, 74%, 93%, and 100%, respectively, at 6 months. Median endothelial cell loss relative to baseline donor cell density was 31% at 6 months. Air was reinjected in 10 eyes (25%) to promote graft attachment, and 2 grafts (5%) failed to clear.
  
  
  CONCLUSIONS
  DMAEK provided significant improvement in visual acuity and marked reduction in central corneal thickness. DMAEK had a higher rate of postoperative air reinjection than Descemet stripping endothelial keratoplasty and comparable 6-month endothelial cell loss.
authors.affiliation: Berkeley Eye Center, Houston, TX, USA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: McCauley
authors.forename: Marianne O
authors.initials: MO
authors.lastname: Price
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Fairchild
authors.forename: David A
authors.initials: DA
authors.lastname: Price
authors.forename: Francis W
authors.initials: FW
authors.lastname: Price
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002452:Cell Count; D002648:Child; D002675:Child, Preschool; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000166:cytology / Q000502:physiology*; D005260:Female; 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; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*