title: Clinical outcome of 500 consecutive cases undergoing Descemet's membrane endothelial keratoplasty.
abstract: OBJECTIVE
  To evaluate the clinical outcome of 500 consecutive cases after Descemet's membrane endothelial keratoplasty (DMEK) and the effect of technique standardization.
  
  
  METHODS
  Prospective, interventional case series at a tertiary referral center.
  
  
  METHODS
  A total of 500 eyes of 393 patients who underwent DMEK for Fuchs' endothelial corneal dystrophy, bullous keratopathy, or previous corneal transplant failure.
  
  
  METHODS
  Best-corrected visual acuity (BCVA), endothelial cell density (ECD), pachymetry, and intraoperative and postoperative complications were evaluated before and 1, 3, and 6 months after DMEK.
  
  
  METHODS
  Comparison between 2 groups (group I: cases 1-250, outcome of "early surgeries" during transition to technique standardization; group II: cases 251-500, outcome of "late surgeries" after technique standardization).
  
  
  RESULTS
  At 6 months, 75% of eyes reached a BCVA of ≥20/25 (≥0.8), 41% of eyes achieved ≥20/20 (≥1.0), and 13% of eyes achieved ≥20/18 (≥1.2) (n=418) when excluding eyes with ocular comorbidities (n=57). When including all available eyes at 6 months (n=475), 66% of eyes reached a BCVA of ≥20/25 (≥0.8), and 36% of eyes achieved ≥20/20 (≥1.0). Mean ECD decreased by 37% (±18%) to 1600 (±490) cells/mm2 (n=447) at 6 months (P<0.001). Postoperative pachymetry averaged 525 (±46) μm compared with 667 (±92) μm preoperatively (P<0.001). None of these parameters differed among the 2 groups (P>0.05). (Partial) graft detachment presented in 79 eyes (15.8%), and 26 eyes (5.2%) required a secondary surgery within the first 6 months (re-bubbling in 15, secondary keratoplasty in 11). With technique standardization, the postoperative complication rate decreased from 23.2% to 10% (P<0.001) and the rate of secondary surgeries decreased from 6.8% to 3.6% (P=0.10).
  
  
  CONCLUSIONS
  In comparison with earlier endothelial keratoplasty techniques, DMEK may consistently give higher visual outcomes and faster visual rehabilitation. When used for the extended spectrum of endothelial pathologies, DMEK proved feasible with a relatively low risk of complications. Technique standardization may have contributed to a lower graft detachment rate and a relatively low secondary intervention rate. As such, DMEK may become the first choice of treatment in corneal endothelial disease.
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands.
authors.forename: Marina
authors.initials: M
authors.lastname: Rodríguez-Calvo-de-Mora
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands.
authors.forename: Ruth
authors.initials: R
authors.lastname: Quilendrino
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands.
authors.forename: Lisanne
authors.initials: L
authors.lastname: Ham
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands.
authors.forename: Vasilios S
authors.initials: VS
authors.lastname: Liarakos
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands.
authors.forename: Korine
authors.initials: K
authors.lastname: van Dijk
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands.
authors.forename: Lamis
authors.initials: L
authors.lastname: Baydoun
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands.
authors.forename: Isabel
authors.initials: I
authors.lastname: Dapena
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands.
authors.forename: Silke
authors.initials: S
authors.lastname: Oellerich
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands. Electronic address: oellerich@niios.com.
authors.forename: Gerrit R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003317:Corneal Dystrophies, Hereditary / Q000503:physiopathology / Q000601:surgery*; D063171:Corneal Pachymetry; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult