Descemet Membrane Endothelial Keratoplasty: Learning Curve and 2-Year Results of a French Series
To describe the results of the first one hundred DMEK cases and compare the first 5 cases to the rest of the series.
Prospective, observational case series of the first 100 eyes of 87 patients undergoing a DMEK surgery at the author’s institution by a single surgeon. The endothelio-Descemet graft was manually prepared in the operating room and was inserted in the receiver Anterior Chamber using a dedicated single use injector after removal of the recipient Descemet membrane. All the surgeries were recorded. Surgery and graft preparation time as well as clinical outcomes at 1,6, 12 and 24 months were compared between the first 5 cases, and the rest of the group.
Among the 2 groups clinical outcomes were similar, with 80% of cases achieving a BCVA of 0.1LogMar and an average ECD of 1570 cells/mm2 at 24 months. Mean graft preparation time (GPT) and mean surgical time (ST) were 44 +/- 20 minutes and 56 +/- 18 mn respectively in the first 5 cases and 21 +/- 8 minutes and 29 +/- 16 mn in the rest of the group and the differences were statistically significant (p<0.05). Mean graft unfolding time (GUT) was 25 +/- 10 mn in the first 5 cases and 10 +/- 8 mn in the rest of the group (p<0.05). In the first 5 cases we were not able to complete the donor preparation in one case and the graft was wrongly oriented in another case.
The learning curve in DMEK did not correlate with clinical outcome at 2 years. However, ST, GPT, GUT and intraoperative complications decline with the surgeon experience.