Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases

Abstract

Purpose: To evaluate the clinical outcome and complications of Descemet membrane endothelial keratoplasty (DMEK), using Descemet-stripping endothelial keratoplasty (DSEK) as a back-up procedure, in the management of Fuchs endothelial dystrophy. Design: Non-randomised prospective clinical study. Methods: The first fifty consecutive eyes that underwent DMEK, that is, transplantation of an isolated donor Descemet membrane carrying its endothelium, for Fuchs endothelial dystrophy were evaluated. In all eyes, the best-corrected visual acuity (BCVA) as well as the endothelial cell density (ECD) was measured before and at 6 months after surgery, as clinical outcome parameters. Results: Ten patients required a secondary DSEK for failed DMEK. In the remaining 40 DMEK eyes, 95% had a BCVA of X20/40 (X0.5) and 75% X20/25 (X0.8) at 6 months after surgery. ECD averaged 2618 ( ± 201) cells/mm 2 before, and 1876 ( ± 522) cells/mm 2 at 6 months after surgery (n ¼ 35). When the outcomes of DMEK and secondary DSEK procedures were combined, 94% reached a BCVA of X20/40 (X0.5) and 66% X20/25 (X0.8) (n ¼ 47), and ECD averaged 2623 ( ± 193) cells/mm 2 before, and 1815 ( ± 578) cells/mm 2 at 6 months after surgery (n ¼ 43). Conclusion: With DSEK as a back-up procedure, DMEK may provide relatively quick and complete visual rehabilitation in a majority of patients operated on for Fuchs endothelial dystrophy. Endothelial cell survival may be similar to earlier types of (lamellar) keratoplasty. Early graft detachment was the main complication in this first series of DMEK surgeries for Fuchs endothelial dystrophy.

Determinants of visual quality after endothelial keratoplasty

“…[46][47]50,76,97,[103][104][105]123 Tourtas et al found that central corneal thickness reduced from 652+/-92 microns to 517+/-45 microns after DMEK and from 698+/-137 microns to 618+/-66 microns after DSAEK. 123 This difference in thickness is one explanation for the improved visual outcomes.…”

“…133 Faster and improved visual rehabilitation has been achieved with DMEK. 46,48,70 In the largest series of DMEK reported to date, 41% eyes without ocular comorbidity attained BCVA of 20/20 or better at six months.…”

Complicações em transplantes endoteliais realizados por estagiários de córnea

“…Nessa técnica cirúrgica, a córnea receptora é preparada com o "stripping" da mesma forma que o DSEK/DSAEK, mas a córnea doada consiste apenas da membrana de Descemet e endotélio, sem estroma associado. Os resultados visuais são superiores e com uma reabilitação visual mais rápida (19)(20)(21) . Mas é uma técnica cirúrgica mais difícil, com número maior de complicações nas primeiras publicações (19)(20)(21) .…”

“…Os resultados visuais são superiores e com uma reabilitação visual mais rápida (19)(20)(21) . Mas é uma técnica cirúrgica mais difícil, com número maior de complicações nas primeiras publicações (19)(20)(21) . Poucos cirurgiões no mundo realizam essa técnica com bons resultados e baixo índice de complicações.…”

Must Know Cornea for Cataract Surgeons A Practical Guide

“…Review of several studies done in North America identified Fuchs' corneal dystrophy as the second most common www.jors.js.iknito.com indication for keratoplasty (15%) ranking second after pseudophakic bullous keratopathy (PBK) (38%) [17][18][19] . Significant proportion of patients with Fuchs dystrophy remain compensated for life and will benefit from cataract surgery to improve their vision, hence the need to minimize further damage on their corneas during cataract surgeries.…”