Safety in Learning DMEK: Complications, Endothelial Cell Loss, and Visual Outcomes in a Comparative Case Series of Fellows Versus Attendings

Sunday, April 19, 2015: 3:11 PM
Room 5A (San Diego Convention Center)
Christopher S. Sales, MD, MPH
Peter B. Veldman, MD
Mark A. Terry, MD
Zachary M. Mayko, MS
Michael D. Straiko, MD

Purpose
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.

Methods
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).

Results
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).

Conclusion
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.