Three-Year Outcome Comparison Between Femtosecond Laser-Assisted and Manual Descemet Membrane Endothelial Keratoplasty

Abstract

Purpose: To evaluate 3-year outcomes of femtosecond laser-assisted Descemet membrane endothelial keratoplasty (F-DMEK) compared with manual Descemet membrane endothelial keratoplasty (M-DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD). Methods: A retrospective, interventional study, including eyes with FECD and cataract that underwent either F-DMEK or M-DMEK combined with cataract extraction at either the Toronto Western Hospital or Kensington Eye Institute, and that had at least 18 months' follow-up was conducted. Exclusion criteria: complicated anterior segments, previous vitrectomy, previous keratoplasty, corneal opacity, or any other visually significant ocular comorbidity. Results: Included were 16 eyes of 15 patients in the F-DMEK group (average follow-up 33.0 ± 9.0 months) and 45 eyes of 40 patients in the M-DMEK group (average follow-up 32.0 ± 7.0 months). There were no issues with the creation of femtosecond descemetorhexis (in the F-DMEK group)—all descemetorhexis cuts were complete. Best spectacle-corrected visual acuity improvement did not differ significantly between the groups at 1, 2, and 3 years (P = 0.849, P = 0.465 and P = 0.936, respectively). Rates of significant detachment in F-DMEK and M-DMEK were 1 of 16 eyes (6.25%) and 16 of 45 eyes (35.6%) (P = 0.027). Rebubbling rates were 1 of 16 eyes (6.25%) and 15 of 45 eyes (33.3%) (P = 0.047). Cell-loss rates following F-DMEK and M-DMEK were 26.8% and 36.5% at 1 year (P = 0.042), 30.5% and 42.3% at 2 years (P = 0.008), 37% and 47.5% at 3 years (P = 0.057), respectively. Graft failure rate was 0% in F-DMEK and 8.9% in M-DMEK (all were primary failures; P = 0.565). Conclusions: F-DMEK showed good efficacy with reduced detachment, rebubble, and cell-loss rates, compared with M-DMEK.

Descemet membrane endothelial keratoplasty in patients with prior glaucoma surgery

“…10 These outcomes are comparable to ours but are not as good as in other scenarios such as in patients undergoing DMEK for Fuch's endothelial dystrophy alone. 3,15 Nevertheless, significant BSCVA improvement was seen in our cohort, even in eyes that had visually limiting comorbidities. This could be clinically and functionally significant for such individuals who often suffer from bilateral low-vision.…”

Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma

“…It may not be the filtrating effect that is decisive, but the mechanical effect of the GDD, which induces dysfunction of the endothelial cells. In eyes without graft failure, however, the endothelial cell loss after 36 months was 33.9%, which is in the normal range compared to other studies [30,32]. Other studies showed significant differences in endothelial cell loss between eyes with a previous glaucoma surgery and a control group only in the long-term follow-up [8,14,16], while especially GDD are well known for high endothelial loss rates [33].…”

Descemet membrane endothelial keratoplasty: Update on preoperative considerations, surgical techniques, and outcomes

“…In a comparative study of 16 eyes with FECD, eyes that underwent F-DMEK had significantly less rate of postoperative graft detachment and consequently less number of rebubblings required. [ 155 ] Endothelial cell loss was significantly lower in the F-DMEK group till 2 years follow-up.…”