title: Multicenter study of descemet membrane endothelial keratoplasty: first case series of 18 surgeons.
abstract: OBJECTIVE
  Surgeons starting to perform Descemet membrane endothelial keratoplasty (DMEK) should be informed about the learning curve and experience of others.
  
  
  OBJECTIVE
  To document the clinical outcome of standardized "no-touch" DMEK and its complications during the learning curves of experienced surgeons.
  
  
  METHODS
  Retrospective multicenter study. A total of 431 eyes from 401 patients with Fuchs endothelial dystrophy (68.2%) and bullous keratopathy (31.8%) underwent DMEK performed by 18 surgeons in 11 countries.
  
  
  METHODS
  Descemet membrane endothelial keratoplasty.
  
  
  METHODS
  Best-corrected visual acuity (BCVA), endothelial cell density, and intraoperative and postoperative complications.
  
  
  RESULTS
  Of 275 eyes available for BCVA pooled analysis, BCVA improved in 258 eyes (93.8%), remained unchanged in 12 (4.4%), and deteriorated in 5 (1.8%). Two hundred seventeen eyes (78.9%) reached a BCVA of at least 20/40 (≥0.5), 117 (42.5%) at least 20/25 (≥0.8), and 61 (22.2%) at least 20/20 (≥1.0). Eyes with at least 6 months of follow-up (n = 176) reached similar BCVA outcomes. Mean (SD) decrease in endothelial cell density at 6 months was 47% (20%) (n = 133 [P = .02]). Intraoperative complications were rare, including difficulties in inserting, unfolding, or positioning of the graft (1.2%) and intraoperative hemorrhage (0.5%). The main postoperative complication was graft detachment (34.6%); 20.4% underwent a single rebubbling procedure, occasionally requiring a second (2.6%) and a third rebubbling (0.7%), and 17.6% underwent a second keratoplasty.
  
  
  CONCLUSIONS
  Our multicenter study showed that the standardized no-touch DMEK technique was feasible in most hands. The main challenges for surgeons starting to perform the procedure may be (1) to decide whether graft preparation is outsourced or performed during surgery, (2) to limit the number of graft detachments and secondary procedures, and (3) to obtain organ cultured donor corneal tissue.
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the Netherlands.
authors.forename: Claire
authors.initials: C
authors.lastname: Monnereau
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the Netherlands2Melles CorneaClinic Rotterdam, Rotterdam, the Netherlands.
authors.forename: Ruth
authors.initials: R
authors.lastname: Quilendrino
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the Netherlands2Melles CorneaClinic Rotterdam, Rotterdam, the Netherlands3Amnitrans Eyebank Rotterdam, Rotterdam, the Netherlands.
authors.forename: Isabel
authors.initials: I
authors.lastname: Dapena
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the Netherlands2Melles CorneaClinic Rotterdam, Rotterdam, the Netherlands.
authors.forename: Vasilios S
authors.initials: VS
authors.lastname: Liarakos
authors.affiliation: Instituto Oftalmológico Fernández-Vega, Universidad de Oviedo, Madrid, Spain.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Alfonso
authors.affiliation: Department of Ophthalmology, Hospital Universitario Ramon y Cajal, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Arnalich-Montiel
authors.affiliation: Augentagesklinik und Laserzentrum, Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Böhnke
authors.affiliation: Banco de Olhos de Sorocaba, Sorocaba, Brazil.
authors.forename: Nicolas Cesário
authors.initials: NC
authors.lastname: Pereira
authors.affiliation: Department of Ophthalmology, General Hospital Linz, Linz, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Dirisamer
authors.affiliation: Callahan Eye Hospital, University of Alabama, Birmingham.
authors.forename: John
authors.initials: J
authors.lastname: Parker
authors.affiliation: Department of Ophthalmology, Philipps University Marburg, Marburg, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Droutsas
authors.affiliation: Department of Ophthalmology, Heinrich-Heine-Universität Dusseldorf, Dusseldorf, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Geerling
authors.affiliation: Augenklinik am Neumarkt, Köln, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Gerten
authors.affiliation: NOOR Ophthalmology Research Center, NOOR Eye Hospital, Tehran, Iran.
authors.forename: Hassan
authors.initials: H
authors.lastname: Hashemi
authors.affiliation: Department of Ophthalmology, Kanazawa University, Kanazawa, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: Instituto Oftalmológico Fernández-Vega, Universidad de Oviedo, Madrid, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Naveiras
authors.affiliation: Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia.
authors.forename: Oganes
authors.initials: O
authors.lastname: Oganesyan
authors.affiliation: La Unidad Oftalmológica Balear, Clinica Palmaplanas Palma de Mallorca, Mallorca, Spain.
authors.forename: Emeterio
authors.initials: E
authors.lastname: Orduña Domingo
authors.affiliation: Department of Ophthalmology, General Hospital Linz, Linz, Austria.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Priglinger
authors.affiliation: Gemini Eye Clinic, Zlin, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Stodulka
authors.affiliation: Centro Oftalmologico Sertãozinho, Sao Paulo, Brazil.
authors.forename: José
authors.initials: J
authors.lastname: Torrano Silva
authors.affiliation: University Eye Clinic, Genova, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Venzano
authors.affiliation: Cornea Bank, Mainz, Germany.
authors.forename: Jan Markus
authors.initials: JM
authors.lastname: Vetter
authors.affiliation: Tuen Mun Eye Center, Hong Kong Special Administrative Region.
authors.forename: Evan
authors.initials: E
authors.lastname: Yiu
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the Netherlands2Melles CorneaClinic Rotterdam, Rotterdam, the Netherlands3Amnitrans Eyebank Rotterdam, Rotterdam, the Netherlands.
authors.forename: Gerrit R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001768:Blister / Q000601:surgery; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology; D009926:Organ Preservation; D011183:Postoperative Complications; D012189:Retrospective Studies; D013048:Specimen Handling; D014019:Tissue Donors; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult