title: Superior versus temporal approach in descemet membrane endothelial keratoplasty.
abstract: OBJECTIVE
  To compare superior vs temporal approach in patients who underwent Descemet membrane endothelial keratoplasty (DMEK).
  
  
  METHODS
  Monocentric, prospective nonmasked study.
  
  
  METHODS
  A prospective analysis of 53 DMEKs between January and September 2013 was performed at the Charité-Universitätsmedizin Berlin. Only DMEK cases with an incision size of 2.3 mm and with at least 1 month of follow-up were included. The surgically induced astigmatism (SIA), changes in corneal aberrations and in spherical equivalent, visual acuity, endothelial cell density, and complications were evaluated.
  
  
  RESULTS
  Visual acuity improved significantly (0.70 ± 0.39 logMAR vs 0.32 ± 0.31 logMAR after 1 month (n = 48), 0.19 ± 0.15 logMAR after 3 months (n = 46), and 0.16 ± 0.17 logMAR after 6 months (n = 47) (P < .001)) regardless of the approach. SIA was significantly lower after temporal than after superior approach (1.42 ± 0.91 diopters [D] [n = 13] vs 0.81 ± 0.68 D [n = 13], P = .038). Change in total root mean square of all aberrations (RMS) (P = .046) at 6 mm pupil diameter, and change in total RMS (P = .019), third-order aberrations (P = .007), and fourth-order aberrations (P = .041) at 4 mm pupil diameter, demonstrated significantly lower results after temporal compared to superior approach. A higher rate of eyes after temporal approach underwent at least 1 rebubbling (39.1% vs 26.7%, P = .252). The endothelial cell density (P = .053) and the change in spherical equivalent (P = .145) did not differ significantly.
  
  
  CONCLUSIONS
  The temporal approach induces significantly less SIA and corneal aberration. There are no significant differences between superior and temporal approach according to the change in spherical equivalent, visual acuity, and endothelial cell density. The need for rebubbling is higher using the temporal approach.
authors.affiliation: Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany. Electronic address: anna-karina.maier@charite.de.
authors.forename: Anna-Karina B
authors.initials: AK
authors.lastname: Maier
authors.affiliation: Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Enken
authors.initials: E
authors.lastname: Gundlach
authors.affiliation: Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Gonnermann
authors.affiliation: Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Matthias K J
authors.initials: MK
authors.lastname: Klamann
authors.affiliation: Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Antonia M
authors.initials: AM
authors.lastname: Joussen
authors.affiliation: Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Eckart
authors.initials: E
authors.lastname: Bertelmann
authors.affiliation: Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Necip
authors.initials: N
authors.lastname: Torun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D057108:Corneal Wavefront Aberration / Q000209:etiology; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology