gms | German Medical Science

Purpose: To assess the clinical outcome of the first consecutive series of Quarter-Descemet Membrane Endothelial Keratoplasty (Quarter-DMEK), a hybrid technique between Descemet membrane endothelial transfer (DMET) and conventional, circular DMEK.

Method: Prospective interventional case series of eleven eyes of 11 patients with central Fuchs endothelial dystrophy underwent Quarter-DMEK, i.e. transplantation of a quadrant of a full-diameter Descemet membrane (DM), and had best corrected visual acuity (BCVA), endothelial cell density (ECD) and its complications evaluated up to 6 months postoperatively.

Result: At one month postoperatively 10/11 (91%) eyes reached a BCVA of ≥20/40 (≥0.5), 3/11 (27%) ≥20/25 (≥0.8) and 2/11 (18%) ≥20/20 (≥1.0). All eyes that reached the 3 and 6 months follow-up had a BCVA of ≥20/25 (≥0.8). Mean central ECD decreased from 2844 (±181) cells/mm² before to 1293 (±439) cells/mm² at one month after surgery. Re-bubbling was performed in 2/11 eyes (18%) within the first postoperative month. Glaucoma developed in 3/11 (27%) eyes that was managed with topical and/or oral medication.

Conclusion: Quarter-DMEK may be a feasible procedure that allows for visual outcomes similar to convention, circular DMEK. The relatively large drop in ECD within the first month may have resulted from more extensive endothelial cell migration and/or measurement error (at the graft edges). If longer term outcomes would resemble those of conventional DMEK, Quarter-DMEK may potentially quadruple the availability of endothelial grafts.