Safety in Learning DMEK: Complications, Endothelial Cell Loss, and Visual Outcomes in a Comparative Case Series of Fellows Versus Attendings
To compare early postoperative complications as well as 6-month endothelial and visual acuity outcomes in DMEK cases performed by attending and fellow corneal surgeons.
A series of 100 consecutive DMEK cases (50 triple-procedures) performed by two fellows (38 total, 18 triple-procedures) and two attendings (62 total, 32 triple-procedures) were analyzed for frequency of re-bubbles and iatrogenic primary graft failure (iPGF), as well as 6-month postoperative endothelial cell loss (ECL) and visual acuity (BSCVA).
Re-bubbles were performed in 3/62 attending- compared to 4/38 fellow-cases (P=0.42) and iPGF occurred in 2/62 attending- compared to 2/38 fellow-cases (P=0.63). No further iPGF occurred in either group following introduction of an S-stamp (69 cases). 6-month average BSCVA was 20/26 (n=46) in the attending group compared to 20/26 (n=30) in the fellow group (P=0.71). Percent endothelial cell loss was 30 +/- 17% vs. 29 +/- 15% in the attending (n=44) and fellow (n=27) groups, respectively (P=0.98).
This series demonstrates no significant difference in early postoperative complications as well as 6-month endothelial and visual acuity outcomes when DMEK is performed by experienced corneal surgeons compared to less experienced fellows.