Visual outcomes of Descemet Membrane Endothelial Keratoplasty at a Single Surgeon United Kingdom Centre

Abstract

Purpose Descemet Membrane Endothelial Keratoplasty (DMEK) is a partial thickness corneal graft which involves replacing a recipient’s Descemet’s membrane and endothelium with healthy tissue. Main advantages include rapid visual recovery, fewer higher order aberrations and low rejection rate. However, DMEK is technically challenging and requires advanced surgical skills. The aim of the audit was to assess visual outcomes of DMEK performed at Luton and Dunstable University Hospital (L&D), United Kingdom. Methods Data was collected retrospectively from April 2015 to November 2018. 57 eyes were analysed (31 male, 26 female). Patient demographic data were collected, as well as indication for surgery and pre‐operative visual acuity. Post‐operative follow‐up visits were analysed, including assessment of visual acuity, complications and graft failure and rejection. Results Pre‐operative visual acuity (Snellen chart) ranged from worse than 6/60 to 6/6. At an average of 6 months post operatively 87% of patients achieved 6/12 vision or better. At 1 year post procedure 59% of patients achieved 6/6 vision or better. At 2 years follow‐up 63% of patients achieved 6/6 vision or better. The most common DMEK related complications were steroid induced raised IOP (n = 9), partial graft detachment or dislocation (n = 8) and need for re‐bubbling (n = 7). 5 patients were listed for Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Conclusions Most patients undergoing DMEK procedure in L&D Hospital achieve 6/12 vision or better from 6 months onwards. Outcomes at 6 months, 1 year and 2 years are in‐line with the guidelines set by the Royal College of Ophthalmologists and previously published data. These are re‐assuring findings which suggest that more advanced corneal techniques can be carried out at single surgeon sites. Future work should aim to collect long term data on outcomes.