title: Descemet's membrane endothelial keratoplasty: prospective study of 1-year visual outcomes, graft survival, and endothelial cell loss.
abstract: OBJECTIVE
  To report 1-year outcomes of Descemet's membrane endothelial keratoplasty (DMEK) performed at 2 centers.
  
  
  METHODS
  Prospective, consecutive, interventional series.
  
  
  METHODS
  Patients with Fuchs' endothelial dystrophy, pseudophakic bullous keratoplasty, or failed previous graft (n = 136 eyes).
  
  
  METHODS
  The diseased central 7 mm of Descemet's membrane (DM) was stripped from the recipient cornea and replaced with healthy DM and endothelium stripped from donor corneas through a 2.8-mm corneal incision. Descemet's membrane endothelial keratoplasty was performed alone (n = 110) or combined with either phacoemulsification and intraocular lens implantation (n = 23) or pars plana vitrectomy (n = 3).
  
  
  METHODS
  Best spectacle-corrected visual acuity (BSCVA), manifest refraction, and endothelial cell density.
  
  
  RESULTS
  Excluding eyes with pre-existing ocular comorbidities or those lost to follow-up, mean BSCVA at 1 year was 0.07 logarithm minimum angle of resolution (logMAR) units (20/24; range, 20/15-20/40; n = 81), improving from 0.51 logMAR (20/65; range, 20/20-counting fingers); 41% of the patients achieved a BSCVA of 20/20 or better, 80% could be corrected to 20/25 or better, and 98% achieved 20/30 or better vision. A refractive hyperopic shift of +0.24 ± 1.01 diopters (D; range, -1.50 to 2.25 D) was found at 1 year, but it was not statistically significant (P = 0.08). Also, there was no significant change in the preoperative astigmatism (P = 0.17). The endothelial cell loss at 1 year was 36 ± 20% (n = 94; range, 13%-88%), with most of the loss being observed during the first 3 months after surgery: 31 ± 18% (range, 3%-77%). The DMEK graft creation could not be successfully completed in 6 cases (4.2%). All these unsuccessful attempts were among the initial 40 cases. Intracameral air was used to fix graft detachments, which usually were partial and peripheral, in 62% of the cases. Eleven grafts (8%) demonstrated primary failure and 1 eye (0.7%) had secondary failure resulting from endothelial rejection. Episodes of immunologic rejection were documented in 7 eyes (5.1%) during the first year of follow-up.
  
  
  CONCLUSIONS
  Descemet's membrane endothelial keratoplasty had better visual acuity results in the first year after surgery than typically reported for other endothelial keratoplasty techniques, such as Descemet's stripping automated endothelial keratoplasty, while having less refractive changes and similar endothelial cell counts but a higher rebubbling rate.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Cornea Research Foundation of America, Indianapolis, Indiana 46260, USA.
authors.forename: Frederico P
authors.initials: FP
authors.lastname: Guerra
authors.forename: Arundhati
authors.initials: A
authors.lastname: Anshu
authors.forename: Marianne O
authors.initials: MO
authors.lastname: Price
authors.forename: Arthur W
authors.initials: AW
authors.lastname: Giebel
authors.forename: Francis W
authors.initials: FW
authors.lastname: Price
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D055954:Corneal Endothelial Cell Loss / Q000473:pathology*; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy