gms | German Medical Science

Purpose: To evaluate the 1-year clinical outcome after semi-circular Descemet membrane endothelial keratoplasty (hemi-DMEK) in a first case series.

Setting/Venue: Netherlands Institute for Innovative Ocular Surgery / Tertiary referral center.

Methods: In three eyes of three patients with Fuchs endothelial dystrophy, best corrected visual acuity (BCVA), endothelial cell density (ECD), pachymetry, and intra- and postoperative complications were evaluated after transplantation of a semi-circular 12 mm diameter Descemet graft (hemi-DMEK graft).

Results: All corneas cleared within 6 months and showed a stable pachymetry thereafter (527, 535 and 490 µm, respectively). Compared to preoperative measurements, average central ECDs dropped by 51% (56, 39, and 59%, respectively) at three months, 53% (57, 38, and 63%, respectively) at 6 months, and 59% (60, 47, and 71%, respectively) at 12 months. Denuded stromal areas adjacent to the graft cleared and at 12 months peripheral ECD counts ranged from 724 to 1051 cells/mm². At 12 months, BCVA was 20/22 (0.9), 20/40 (0.5, amblyopic eye) and 20/17 (1.2). No postoperative complications occurred throughout the study period.

Conclusions: Hemi-DMEK may provide visual outcomes similar to those in routine DMEK at the one year postoperative. If so, hemi-DMEK could become the next step in endothelial keratoplasty, owing to its potential to double the yield of transplants from the same donor pool (two hemi-DMEK grafts can be prepared from one donor cornea).

Financial Disclosure: Dr. Melles is a consultant for D.O.R.C. International BV/Dutch Ophthalmic USA, and SurgiCube International. The other authors have no conflict of interest to disclose.