Surgeons starting to perform Descemet membrane endothelial keratoplasty (DMEK) should be informed about the learning curve and experience of others. OBJECTIVE To document the clinical outcome of standardized "no-touch" DMEK and its complications during the learning curves of experienced surgeons. DESIGN, SETTING, AND PARTICIPANTS Retrospective multicenter study. A total of 431 eyes from 401 patients with Fuchs endothelial dystrophy (68.2%) and bullous keratopathy (31.8%) underwent DMEK performed by 18 surgeons in 11 countries. EXPOSURES Descemet membrane endothelial keratoplasty. MAIN OUTCOMES AND MEASURES Best-corrected visual acuity (BCVA), endothelial cell density, and intraoperative and postoperative complications. RESULTS Of 275 eyes available for BCVA pooled analysis, BCVA improved in 258 eyes (93.8%), remained unchanged in 12 (4.4%), and deteriorated in 5 (1.8%). Two hundred seventeen eyes (78.9%) reached a BCVA of at least 20/40 (Ն0.5), 117 (42.5%) at least 20/25 (Ն0.8), and 61 (22.2%) at least 20/20 (Ն1.0). Eyes with at least 6 months of follow-up (n = 176) reached similar BCVA outcomes. Mean (SD) decrease in endothelial cell density at 6 months was 47% (20%) (n = 133 [P = .02]). Intraoperative complications were rare, including difficulties in inserting, unfolding, or positioning of the graft (1.2%) and intraoperative hemorrhage (0.5%). The main postoperative complication was graft detachment (34.6%); 20.4% underwent a single rebubbling procedure, occasionally requiring a second (2.6%) and a third rebubbling (0.7%), and 17.6% underwent a second keratoplasty.CONCLUSIONS AND RELEVANCE Our multicenter study showed that the standardized no-touch DMEK technique was feasible in most hands. The main challenges for surgeons starting to perform the procedure may be (1) to decide whether graft preparation is outsourced or performed during surgery, (2) to limit the number of graft detachments and secondary procedures, and (3) to obtain organ cultured donor corneal tissue.

The implantation of ICRSs using the femtosecond laser for residual astigmatism post-PKP was safe and showed satisfactory results. It reduced refractive astigmatism and maximum corneal curvature and improved UDVA and CDVA.

Purpose: To describe the outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed by cornea fellows during their initial learning curve. Methods: This prospective study included the first consecutive series of 53 DMEK surgeries performed by 14 corneal fellows at Sorocaba's Ophthalmological Hospital. Best spectacle-corrected visual acuity, endothelial cell density (ECD), and complications were evaluated. Results: Of the eyes without ocular comorbidities and with complete visual acuity measurements, 97% of 33 eyes achieved a best spectacle-corrected visual acuity of ≥20/40 in 6 months. The mean (SD) preoperative donor ECD was 2453 (361) cells/mm2, and at 6 months postoperatively, the in vivo mean ECD (SD) was found to be 1300 (587) cells/mm2, an average loss of 47%. Preparation of the DMEK graft by the cornea fellows was successful in all cases. There were 9 eyes (17%) that experienced partial graft detachment requiring rebubbling. A total of 3 eyes (5.7%) failed to clear the cornea, all of which were managed with successful secondary endothelial keratoplasty. None of the eyes experienced pupillary block. Conclusions: Establishing DMEK in a fellowship program was successful with the supervision of an experienced DMEK surgeon. Even without the facility of a prestripped DMEK graft by an eye bank and with no backup tissue, no surgery was canceled because of graft preparation failure. Good visual outcomes were achieved with satisfactory ECD at 6-month follow-up, with an acceptable complication rate. Even the 3 eyes that failed to clear the cornea evolved well after secondary endothelial keratoplasty by the cornea fellows.