DMEK outcomes

Descemet’s membrane endothelial keratoplasty (DMEK) results in good visual outcomes in the majority of eyes that undergo the procedure, although starting DMEK surgeons may experience higher complication rates than experienced DMEK surgeons, according to the results of a large retrospective study presented at the 8th EuCornea Congress in Lisbon, Portugal. “Our multi-centre study shows that standardised ‘no-touch’ DMEK is feasible for surgeons in various settings, with good clinical outcomes in terms of visual acuity and ECD decrease,” said Silke Oellerich PhD, Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands. The retrospective, interventional cohort study involved 2,485 eyes undergoing DMEK in 55 centres in 23 countries. The indications for surgery were Fuchs endothelial corneal dystrophy in 74%, bullous keratopathy in 17%, transplant failure in 8% or other indications in 1%, Dr Oellerich noted. At six months follow-up, BCVA had improved in 90.5% of eyes, remained unchanged in 4.6% and deteriorated in 4.9%. In addition, BCVA was 20/40 or better in 75.4%, 20/25 or better in 45.4% and 20/20 or better in 25.8% for the entire group, with no eyes excluded because of low visual potential. Dr Oellerich noted endothelial cell density (ECD) decreased by a mean of 40%. Intraoperative complications, such as difficulties inserting and manipulating the graft tissue, were reported for 9.4% of eyes. Graft detachment was the main postoperative complication and occurred in 27.4% of eyes, of which 14.9% had only a small detachment (<1/3 of the graft surface area). [caption id="attachment_10071" align="alignleft" width="1024"] World map displaying participating surgeons and their locations. Numbers indicate the number of surgeons per country (published as supplemental digital content in Oellerich et al. Cornea. 2017 Sep 26 Epub ahead of print])[/caption] BETTER RESULTS AS SURGEONS GAIN EXPERIENCE To assess the impact of experience with the technique on outcomes, they divided the surgeries into the surgeons’ first 24 or fewer DMEKs (group I), their 25th to 99th DMEKs (group II) and DMEK case numbers 100 or higher (group III). BCVA and ECD outcomes did not differ between beginning and experienced DMEK surgeons (P=.07 and P=.53, respectively). However, group III surgeons had lower intraoperative complications (16% vs 5%) and graft detachment rates (34% vs 22%) than those in group I (P<0.05). For example, re-bubbling was performed in 20% of eyes overall, but in only 18% of eyes in group III compared to 24% in group I. Likewise, repeat transplantations were necessary within six months in 18% group I eyes versus 9% in group II. “Virtually all transplant-related complications declined with experience. Notably, surgeons with a higher annual caseload may pass faster through their learning curve than surgeons performing their first surgeries over an extended period,” Dr Oellerich said. Silke Oellerich: oellerich@niios.com

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