Multicenter Trial of DMEK: First Case Series of 18 Surgeons
Narrative Responses:
Purpose
To document the clinical outcome of standardized ‘no-touch’ Descemet membrane endothelial keratoplasty (DMEK) and its complications during the learning curve of experienced surgeons.
Methods
Retrospective multicenter interventional study. Participants: A total of 431 eyes of 401 patients. Methods. DMEK was performed for Fuchs endothelial dystrophy (68%), bullous keratopathy (28%) or other indications (4%) by 18 different surgeons in 11 countries. Main Outcome Measures. Best corrected visual acuity (BCVA), endothelial cell density and intra- and postoperative complications were recorded.
Results
Visual acuity data up to 6 months were pooled (n=275) and showed that 217 eyes (79%) reached a BCVA of ≥20/40, 117 eyes (43%) ≥20/25, and 61 (22%) ≥20/20. Average decrease in endothelial cell density at 6 months was 47% (n=133). Intraoperative complications were rare, including difficulties in inserting, unfolding or positioning the graft (1%) and hemorrhage (0.5%). The main postoperative complication was graft detachment (35%); 20% underwent a single rebubbling procedure, occasionally requiring a second or third rebubbling (3% and 1%, respectively), and 18% a secondary keratoplasty.
Conclusion
Our multicenter trial showed that the standardized DMEK technique was feasible in most hands. When successful, the visual outcome after DMEK may be relatively independent of the technique’s learning curve.