title: Efficacy of descemet membrane endothelial keratoplasty: clinical outcome of 200 consecutive cases after a learning curve of 25 cases.
abstract: OBJECTIVE
  To evaluate Descemet membrane endothelial keratoplasty for management of corneal endothelial disorders.
  
  
  METHODS
  Descemet membrane endothelial keratoplasty was performed in 200 patients with Fuchs endothelial dystrophy or bullous keratopathy. Best-corrected visual acuity, subjective and objective refractive outcome and stability, and endothelial cell density were evaluated at 1, 3, and 6 months postoperatively, and intraoperative and postoperative complications were documented.
  
  
  RESULTS
  At 6 months, 94% reached a best-corrected visual acuity of 20/40 or better (≥0.5); 77%, 20/25 or better (≥0.8); 47%, 20/20 or better (≥1.0), and 16%, 20/17 or better (≥1.2) (n = 159). The preoperative to 6 months' postoperative spherical equivalent showed a mean (SD) +0.38 (1.2) diopter hyperopic shift (P = .001) that correlated with a decrease in central corneal thickness (n = 143) (P = .047). Two-thirds of eyes showed refractive stability at 3 months. Donor endothelial cell density showed a decrease from mean (SD) 2560 (186) cells/mm(2) preoperatively to 1690 (520) cells/mm(2) at 6 months after surgery (n = 173) (P < .001). Graft detachment was the main complication and occurred in 18 eyes (9%). Recipient Descemet membrane remnants were present in 12 eyes (6%). Secondary glaucoma was seen in 8 eyes (4%), of which 4 showed air-bubble dislocation behind the iris. In 2 of 33 phakic eyes (6%), a secondary cataract developed requiring phacoemulsification.
  
  
  CONCLUSIONS
  Descemet membrane endothelial keratoplasty may offer complete visual rehabilitation within 1 to 6 months after surgery in a majority of eyes. Similar to earlier keratoplasty techniques, Descemet membrane endothelial keratoplasty may be associated with a one-third decrease in donor endothelial cell density in the early postoperative phase. Incidence of (partial) graft detachment stabilized at about 5% but could be further reduced by patient selection and/or technique modification.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00521898.
authors: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands.
authors: Martin
authors: M
authors: Dirisamer
authors: Lisanne
authors: L
authors: Ham
authors: Isabel
authors: I
authors: Dapena
authors: Kyros
authors: K
authors: Moutsouris
authors: Konstantinos
authors: K
authors: Droutsas
authors: Korine
authors: K
authors: van Dijk
authors: Laurence E
authors: LE
authors: Frank
authors: Silke
authors: S
authors: Oellerich
authors: Gerrit R J
authors: GR
authors: Melles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001768:Blister / Q000503:physiopathology / Q000601:surgery; D002452:Cell Count; D019781:Corneal Topography; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D007431:Intraoperative Complications; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome; D014786:Vision Disorders / Q000534:rehabilitation*; D014792:Visual Acuity / Q000502:physiology