Preferred practice pattern for Descemet membrane endothelial keratoplasty surgeries: A survey of Indian corneal surgeons

Abstract

Purpose: This study aims to assess the preferred surgical technique of Descemet membrane endothelial keratoplasty (DMEK) among corneal surgeons in India, and barriers in performing DMEK surgeries amongst the non-DMEK surgeons. Methods: An online, questionnaire-based, cross-sectional survey was conducted among members of the Cornea Society of India (CSI) (n = 500). Responses on their surgical experience, preferred technique, complications, and outcome of DMEK were collected and analyzed. Barriers in performing DMEK surgeries were assessed amongst the non-DMEK surgeons. Results: A total of 100 responses were obtained and response rate for the survey was 20%. DMEK was performed by 55% of the participants of whom only 40% had formal training in this technique. Surgical video-based learning was the most often used self-training method for others. Lack of training was the most common reason for not performing DMEK by the non-DMEK surgeons. Descemet stripping endothelial keratoplasty (DSEK) was the most common endothelial keratoplasty (EK) performed by both DMEK and non-DMEK surgeons. High volume (>50 cases) DMEK surgeries were reported by limited surgeons (n = 6). Nearly all the DMEK surgeons prepared the donor tissue by themselves on the day of the surgery, and majority felt that unrolling the graft in the anterior chamber was the most difficult surgical step. Nearly 80% of the DMEK surgeons were more comfortable with DSEK or Descemet stripping automated endothelial keratoplasty (DSAEK) when compared to DMEK. Conclusion: DMEK practice in India needs improvement with increased accessibility to DMEK training programs, wet lab facilities, and better support from eye banks.

Performance outcomes from a DMEK peeling and preparation wet lab

“…The aforementioned factors emphasise the importance of proficient DMEK surgical training. Wet labs have proven to be an effective method to cultivate surgical skills 8–11. Trainee surgeons practise the technical aspects of DMEK surgery in a controlled risk-free setting to develop confidence and improve surgical performance 12…”

“…Wet labs have proven to be an effective method to cultivate surgical skills. [8][9][10][11] Trainee surgeons practise the technical aspects of DMEK surgery in a controlled risk-free setting to develop confidence and improve surgical performance. 12 Wet labs use ex vivo human donor corneoscleral rims not suitable for transplantation.…”

Trends in keratoplasty from central and northern India. Part II: Types of keratoplasty

“…These include the implementation of hospital corneal retrieval programs, the upgradation of eye banks with microkeratomes to prepare precut tissues for DSEK, the establishment of a robust tissue distribution network across the country in the private sector, and an increase in training programs in lamellar keratoplasties and keratoprostheses (Kpro) techniques. [ 17 18 19 ] Although these developments have led to an increase in lamellar keratoplasties and Kpro surgeries in India,[ 16 20 21 ] the overall impact of these changes on keratoplasty trends in India is still not clearly understood. Therefore, this study aimed to evaluate the trend in keratoplasty surgeries in central and northern India during the past two decades.…”