3D Visualization System in Descemet Membrane Endothelial Keratoplasty (DMEK): A Six-Month Comparison with Conventional Microscope

Abstract

Background: To compare the efficacy and safety of Descemet membrane endothelial keratoplasty (DMEK) surgery using the three-dimensional (3D) display system NGENUITY to DMEK surgery performed with the traditional microscope (TM) in patients affected by Fuchs Endothelial Corneal Disease (FECD). Methods: Retrospective comparative study of 40 pseudophakic eyes of 40 patients affected by FECD who underwent DMEK surgery. Twenty patients (3D group) were operated on using the 3D display system and 20 patients (TM group) were operated on using the traditional microscope. Best spectacle corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD) and corneal densitometry (CD) values were documented before and at 1, 3 and 6 months after DMEK. Intra- and postoperative complications were recorded. Results: The baseline assessments did not differ between the two groups (p > 0.05). Global surgical time and time to perform descemetorhexis were significantly lower in the TM group (p = 0.04 and p = 0.02, respectively). BSCVA, CCT, ECD and CD values did not differ significantly in the two groups at all follow-ups (p > 0.05). Complication rate was similar between the two groups. Conclusion: Three-dimensional display systems can be securely employed in DMEK surgery considering the satisfactory clinical outcomes, including Scheimpflug CD. Nevertheless, the slightly longer surgical time of the 3D DMEKs may lead to surgeons’ hesitancy. The main advantages of the heads-up approach may be the improved ergonomic comfort during surgery and the utility of assistants in surgical training.

Descemet Membrane Endothelial Keratoplasty and Descemet Stripping Only Using a 3D Visualization System

“…Recently, Morelli et al [9] also compared both systems in a sample of 20 eyes operated with the NGENUITY ® and 20 eyes using the OPMI-Lumera 700. All of the patients in this study were affected by FECD.…”

“…DMEK procedures have traditionally been performed using standard surgical microscopes, but, more recently, three-dimensional (3D) visualization systems have also been employed. These systems were originally developed for vitreoretinal surgery [3,4], but their potential for anterior segment procedures has been explored over the last few years, with promising results in cataract [5], trabeculotomy [6], and endothelial procedures such as DMEK [7][8][9]. Performing surgery using these systems allows for an enhanced depth of field, high magnification and better positioning for the surgeon during surgery.…”

“…They indicated that improved visualization allows a reduced staining time, which could be beneficial for eye banks because it may reduce the toxic effect of staining colorants. Recently, Morelli et al [9], in a sample of 20 eyes operated with NGENUITY ® and 20 eyes using the traditional microscope, concluded that the main advantages of the heads-up approach may be the improved ergonomic comfort during surgery and the utility of assistants in surgical training.…”