[Standardized Descemet membrane endothelial keratoplasty (DMEK): technique and latest results].
BACKGROUND
The procedure of posterior lamellar keratoplasty has now become established as first choice therapy for the treatment of corneal endothelial diseases, with Descemet membrane endothelial keratoplasty (DMEK) as the most recent refinement of endothelial keratoplasty techniques. In this study the outcome of 400 consecutive cases after standardized no-touch DMEK was evaluated.


METHODS
This was a non-randomized retrospective clinical study of 400 consecutive eyes in 321 patients who underwent standard DMEK. Outcome measures included best corrected visual acuity (BCVA) preoperatively and postoperatively at 1, 3 and 6 months, endothelial cell density (ECD), pachymetry and complications within the first 6 months. In addition two subgroups were analyzed (subgroup I cases 1-200 and subgroup II cases 201-400).


RESULTS
At 6 months postoperatively 80 % of all eyes had a BCVA of ≥ 20/25 (≥ 0.8), 44 % of ≥ 20/20 (≥ 1.0) and 14 % of ≥ 20/18 (≥ 1.2). There were no significant differences between the two subgroups. The mean ECD preoperatively was 2,542 (± 217) cells/mm(2) and 6 months postoperatively 1,622 (± 500) cells/mm(2). The mean ECD decrease was 36 % 6 months after DMEK. No difference between the subgroups was noted. In 5 % a re-operation was needed of which 75 % were performed in subgroup I.


CONCLUSIONS
With the standardized no-touch DMEK technique a rapid and nearly complete visual rehabilitation as well as ECD values similar to earlier endothelial keratoplasty techniques can be achieved. Therefore DMEK may become the preferred treatment for corneal endothelial disorders.
Netherlands Institute for Innovative Ocular Surgery, Laan op Zuid 88, 3071 AA, Rotterdam, Niederlande.
P P
PP
Ciechanowski
K
K
Droutsas
L
L
Baydoun
M
M
Dirisamer
S
S
Oellerich
G R J
GR
Melles
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000592:standards*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D014792:Visual Acuity; D055815:Young Adult