Descemet membrane endothelial keratoplasty (DMEK): intraoperative and postoperative
            complications and clinical results

Koçluk, Yusuf; Kasım, Burcu; Sukgen, Emine Alyamaç; Burcu, Ayşe

doi:10.5935/0004-2749.20180043

Cited by 9 publications

(10 citation statements)

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“…The central corneal endothelium was photographed, at least 50–100 cells were counted for each image, and the postoperative ECD was calculated. 22 CCT values was measured by high‐resolution rotating Scheimpflug imaging (Pentacam HR; Oculus, Wetzlar, Germany). Anterior segment optical coherence tomography (AS-OCT) (Visante OCT; Carl Zeiss Meditec, Dublin CA, USA) was performed postoperatively in eyes with suspected DM detachment.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand

Lekhanont¹,

Pisitpayat²,

Cheewaruangroj³

et al. 2021

OPTH

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Purpose To investigate the medium-term clinical outcomes and risk factors for primary graft failure after Descemet membrane endothelial keratoplasty (DMEK) in Thai patients. Patients and Methods This is a single-center retrospective cohort study. Sixty-two eyes of 62 patients who underwent DMEK at Ramathibodi Hospital, Bangkok, Thailand, with a minimum of 24-month follow-up were recruited. Preoperative donor and recipient characteristics, intraoperative data, and postoperative outcomes including best-corrected visual acuity (BCVA), graft clarity, endothelial cell density (ECD), central corneal thickness (CCT), and complications were evaluated at 1, 3, 6, 12, and 24 months after surgery. Results The mean age of the patients was 67.2 ± 9.9 years, and 52% were female. The mean follow-up time was 37.5 ± 11.0 months. The most common indications for DMEK were Fuchs’ endothelial corneal dystrophy (FECD) (53.2%) and pseudophakic bullous keratopathy (PBK) (17.7%). Nearly half of patients had triple-DMEK. The median preoperative BCVA was 20/400. Postoperative BCVA of ≥ 20/40 was reached in 37.1% and of ≥ 20/20 in 6.5% after 1 month which increased to 54.8% and 17.7% after 3 months; and to 67.7% and 27.4% after 24 months. Endothelial cell loss (ECL) at 3, 6, 12, and 24 months was 30.5%, 33.8%, 44.4%, and 45.9%, respectively. Graft diameter was the single factor, showing a significant relationship with postoperative ECD. Most frequent postoperative complications included graft detachment (22.6%), increased IOP/glaucoma (17.7%), and primary graft failure (16.1%). In univariate analysis, death-to-operation time and the diagnosis of PBK were significantly associated with the occurrence of primary graft failure. Conclusion DMEK is a safe, effective, and feasible treatment for endothelial failure in Asian eyes. Careful case selection, use of relatively fresh donor tissues, and appropriate surgical techniques can prevent primary graft failure and facilitate optimal outcomes following surgery.

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Section: Methodsmentioning

confidence: 99%

Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand

Lekhanont¹,

Pisitpayat²,

Cheewaruangroj³

et al. 2021

OPTH

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“…A study conducted in Turkey shows that previous surgeries such as vitrectomy and iridectomy may be associated with intraoperative complications. Other factors evidenced by the study as possible predictive factors for intraoperative complications were coexisting ocular pathology and the level of professional experience of surgeons in performing keratoplasty ( 3 ) .…”

Section: Discussionmentioning

confidence: 99%

“…Risks include expulsive choroidal bleeding, positive vitreous pressure that can lead to lens expulsion, iris sphincter trauma and/or vitreous loss and endophthalmitis. These are the most serious possible complications of penetrating keratoplasties when compared to anterior and endothelial lamellar keratoplasties ( 2 - 3 , 8 ) .…”

Section: Discussionmentioning

confidence: 99%

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Fatores clínicos e cirúrgicos e as complicações intraoperatórias em pacientes que realizaram ceratoplastias penetrantes

Cruz

Júnior

Azevedo

et al. 2019

Rev. Latino-Am. Enfermagem

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Objetivo identificar as principais complicações intraoperatórias dos pacientes que realizaram ceratoplastias e sua relação com fatores clínicos e cirúrgicos. Método estudo transversal, observacional. Realizou-se um censo dos pacientes submetidos a ceratoplastias que totalizou 258 procedimentos. Resultados foram registradas 22 complicações intraoperatórias, todas em ceratoplastias penetrantes. Do total, 59,09% foram realizadas em pacientes do sexo masculino com idade média de 58,5 anos. A principal complicação intraoperatória notificada foi a perda vítrea (36,36%). Encontrou-se relação estatisticamente significativa entre a variável “complicação intraoperatória” e as variáveis “cirurgia prévia”, “ceratoplastia combinada com extração de catarata” e “botão corneano do receptor maior que 8,0 mm”. Conclusão identificar as principais complicações intraoperatórias da ceratoplastia possibilita à enfermagem compreender quais fatores podem interferir nesses procedimentos, apontar possíveis fatores preditores das complicações e buscar medidas de controles para que tais complicações não ocorram.

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“…e presence of coexisting ocular pathologies, such as glaucoma tubes, anterior synechiae, iris malformations, and anterior chamber intraocular lenses, increases the risk of intra-and postoperative complications including AC bleeding, bubble dislocation into the vitreous cavity, and graft detachment. When first learning the DMEK procedure, such cases with higher complication risks should be avoided [53,54]. An AC free from OVD, air, and fibrin remnants is the first prerequisite for a successful and safe unfolding.…”

Section: Dmek Unfolding and Air Injectionmentioning

confidence: 99%

Tips, Tricks, and Guides in Descemet Membrane Endothelial Keratoplasty Learning Curve

Borroni

Lossada

Parekh

et al. 2021

Journal of Ophthalmology

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Lamellar keratoplasty is fast becoming the most popular form of corneal transplantation. The adoption of Descemet membrane endothelial keratoplasty (DMEK) in the management of Fuchs endothelial dystrophy and pseudophakic bullous keratopathy is partly responsible for this shift in the paradigm of management of corneal pathology. The learning curve of DMEK, however, has been proven to be much steeper than previous endothelial keratoplasty procedures. To ease the procedure, experts have proposed multiple innovative techniques from tissue preparation to graft unfolding to aid the more novice surgeon. Here, we collate and share tips and tricks from our collective experiences to support the learning curve and outcomes in DMEK for both the novice and more experienced corneal transplant surgeons.

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Descemet membrane endothelial keratoplasty (DMEK): intraoperative and postoperative complications and clinical results

Abstract: Occurrence of intraoperative and postoperative complications was increased in patients with coexisting ocular pathology or complicated endothelial dysfunction and during the surgeon's learning curve of DM endothelial keratoplasty procedures.

Cited by 9 publications

References 0 publications

Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand

Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand

Fatores clínicos e cirúrgicos e as complicações intraoperatórias em pacientes que realizaram ceratoplastias penetrantes

Tips, Tricks, and Guides in Descemet Membrane Endothelial Keratoplasty Learning Curve

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