gms | German Medical Science

To be mentioned in the presentation: Jose F. Alfonso, Francisco Arnalich-Montiel, Matthias Böhnke, Nicolas Cesário Pereira, John Parker, Konstantinos Droutsas, Gerd Geerling, Georg Gerten, Hassan Hashemi, Akira Kobayashi, Miguel Naveiras, Oganes Oganesyan, Emeterio Orduña Domingo, Siegfried Priglinger, Pavel Stodulka, José Torrano Silva Jr., Davide Venzano, Jan Markus Vetter, Evan Yiu

Purpose: To document the clinical outcome of standardized ‘no-touch’ Descemet membrane endothelial keratoplasty (DMEK) and its complications during the learning curve of experienced surgeons.

Design: Retrospective multicenter interventional study.

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

Methods: By 18 different surgeons in 11 countries, DMEK was performed for Fuchs endothelial dystrophy (68%), and bullous keratopathy (32%) in a total of 431 eyes of 401 patients. Best corrected visual acuity (BCVA), endothelial cell density and intra- and postoperative complications were recorded.

Results: Overall, BCVA improved in 258 eyes (94%), remained unchanged in 12 eyes (4%), and deteriorated in 5 eyes (2%). Visual acuity data up to 6 months were pooled (n=275) and showed that 217 eyes (79%) reached a BCVA of ≥20/40 (≥0.5), 117 eyes (43%) ≥20/25 (≥0.8), and 61 (22%) ≥20/20 (≥1.0). Eyes with ≥6 months follow-up (n=176) reached similar BCVA outcomes. Average decrease in endothelial cell density at 6 months was 47% (n=133). Intraoperative complications were rare, including difficulties in inserting, unfolding or positioning of the graft (1%) and intraoperative hemorrhage (0.5%). The main postoperative complication was graft detachment (35%); 20% underwent a single rebubbling procedure, occasionally requiring a second or third rebubbling (3% and 1%, respectively), and 18% underwent a secondary keratoplasty.

Conclusions: Our multicenter study showed that the standardized ‘no-touch’ DMEK technique was feasible in most hands. The main challenges for surgeons starting out with the procedure, may be (1) to decide whether graft preparation is outsourced or performed during surgery; (2) to limit the number of graft detachments and secondary procedures; and (3) to obtain organ cultured donor corneal tissue.