title: Standardization of the Descemet membrane endothelial keratoplasty technique: Outcomes of the first 450 consecutive cases.
abstract: OBJECTIVE
  To evaluate the clinical outcome of the first 450 consecutive cases after Descemet membrane endothelial keratoplasty (DMEK), as well as the effect of standardization of the technique.
  
  
  METHODS
  Comparison between 3 groups: Group I: (cases 1-125), as the extended learning curve; Group II: (cases 126-250), transition to technique standardization; Group III: (cases 251-450), surgery with standardized technique. Best corrected visual acuity, endothelial cell density, pachymetry and intra- and postoperative complications were evaluated before, and 1, 3 and 6 months after DMEK.
  
  
  RESULTS
  At 6 months after surgery, 79% of eyes reached a best corrected visual acuity of≥0.8 and 43%≥1.0. Mean preoperative endothelial cell density was 2,530±220 cells/mm2 and 1,613±495 at 6 months after surgery. Mean pachymetry measured 668±92 μm and 526±46 μm pre- and (6 months) postoperatively, respectively. There were no significant differences in best corrected visual acuity, endothelial cell density and pachymetry between the 3 groups (P > .05). Graft detachment presented in 17.3% of the eyes. The detachment rate declined from 24% to 12%, and the rate of secondary surgeries from 9.6% to 3.5%, from group I to III respectively.
  
  
  CONCLUSIONS
  Visual outcomes and endothelial cell density after DMEK are independent of the technique standardization. However, technique standardization may have contributed to a lower graft detachment rate and a relatively low number of secondary interventions required. 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, The Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, The Netherlands; Hospital Universitario Miguel Servet, Zaragoza, España; Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, España.
authors.forename: M
authors.initials: M
authors.lastname: Satué
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Hospital Regional Carlos Haya, Málaga, España.
authors.forename: M
authors.initials: M
authors.lastname: Rodríguez-Calvo-de-Mora
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Instituto Oftalmológico Fernández-Vega, Oviedo, España.
authors.forename: M
authors.initials: M
authors.lastname: Naveiras
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Hospital Universitario de Álava, Vitoria, España.
authors.forename: J
authors.initials: J
authors.lastname: Cabrerizo
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Hospital Universitario Príncipe de Asturias, Madrid, España.
authors.forename: I
authors.initials: I
authors.lastname: Dapena
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, The Netherlands. Electronic address: research@niios.com.
authors.forename: G R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D063171:Corneal Pachymetry; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods / Q000592:standards*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult
keywords: Bullous keratopathy; Curva de aprendizaje; Descemet membrane endothelial keratoplasty; Distrofia endotelial de Fuchs; Endothelial keratoplasty; Fuchs endothelial dystrophy; Learning curve; Queratopatía bullosa; Trasplante endotelial; Trasplante endotelial con membrana de Descemet