Iofv pub2

Multicenter study of descemet membrane endothelial keratoplasty: first case series of 18 surgeons.

JAMA Ophthalmol. 2014 Oct;132(10):1192-8. doi: 10.1001/jamaophthalmol.2014.1710.

Monnereau C1, Quilendrino R2, Dapena I3, Liarakos VS2, Alfonso JF4, ArnalichMontiel F5, Böhnke M6, Pereira NC7, Dirisamer M8, Parker J9, Droutsas K10, Geerling G11, Gerten G12, Hashemi H13, Kobayashi A14, Naveiras M4, Oganesyan O15, Orduña Domingo E16, Priglinger S8, Stodulka P17, Torrano Silva J Jr18,Venzano D19, Vetter JM20, Yiu E21, Melles GR3.

Author information:  1Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the Netherlands.  2Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the Netherlands2Melles CorneaClinic Rotterdam, Rotterdam, the Netherlands.  3Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the Netherlands2Melles CorneaClinic Rotterdam, Rotterdam, the Netherlands3Amnitrans Eyebank Rotterdam, Rotterdam, the Netherlands.  4Instituto Oftalmológico Fernández-Vega, Universidad de Oviedo, Madrid, Spain.  5Department of Ophthalmology, Hospital Universitario Ramon y Cajal, Madrid, Spain.  6Augentagesklinik und Laserzentrum, Hamburg, Germany.  7Banco de Olhos de Sorocaba, Sorocaba, Brazil.  8Department of Ophthalmology, General Hospital Linz, Linz, Austria.  9Callahan Eye Hospital, University of Alabama, Birmingham. 

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Department of Ophthalmology, Philipps University Marburg, Marburg, Germany.

 11Department of Ophthalmology, Heinrich-Heine-Universität Dusseldorf, Dusseldorf, Germany. 

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Augenklinik am Neumarkt, Köln, Germany.

NOOR Ophthalmology Research Center, NOOR Eye Hospital, Tehran, Iran.

Department of Ophthalmology, Kanazawa University, Kanazawa, Japan.

Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia.

La Unidad Oftalmológica Balear, Clinica Palmaplanas Palma de Mallorca, Mallorca, Spain.

Gemini Eye Clinic, Zlin, Czech Republic.

Centro Oftalmologico Sertãozinho, Sao Paulo, Brazil.

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University Eye Clinic, Genova, Italy.

Cornea Bank, Mainz, Germany.

Tuen Mun Eye Center, Hong Kong Special Administrative Region.

Abstract IMPORTANCE: Surgeons starting to perform Descemet membrane endothelial keratoplasty (DMEK) should be informed about the learning curve and experience of others.

OBJECTIVE: To document the clinical outcome of standardized "no-touch" DMEK and its complications during the learning curves of experienced surgeons.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective multicenter study. A total of 431 eyes from 401 patients with Fuchs endothelial dystrophy (68.2%) and bullous keratopathy (31.8%) underwent DMEK performed by 18 surgeons in 11 countries.

EXPOSURES: Descemet membrane endothelial keratoplasty.

MAIN OUTCOMES AND MEASURES: Best-corrected visual acuity (BCVA), endothelial cell density, and intraoperative and postoperative complications.

RESULTS: Of 275 eyes available for BCVA pooled analysis, BCVA improved in 258 eyes (93.8%), remained unchanged in 12 (4.4%), and deteriorated in 5 (1.8%). Two hundred seventeen eyes (78.9%) reached a BCVA of at least 20/40 (≥0.5), 117 (42.5%) at least 20/25 (≥0.8), and 61 (22.2%) at least 20/20 (≥1.0). Eyes with at least 6 months of follow-up (n = 176) reached similar BCVA outcomes. Mean (SD) decrease in endothelial cell density at 6 months was 47% (20%) (n = 133 [P = .02]). Intraoperative complications were rare, including difficulties in inserting, unfolding, or positioning of the graft (1.2%) and intraoperative hemorrhage (0.5%). The main postoperative complication was graft detachment (34.6%); 20.4% underwent a single rebubbling procedure, occasionally requiring a second (2.6%) and a third rebubbling (0.7%), and 17.6% underwent a second keratoplasty.

CONCLUSIONS AND RELEVANCE: Our multicenter study showed that the standardized no-touch DMEK technique was feasible in most hands. The main challenges for surgeons starting to perform 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.

PMID: 24993643 [PubMed - indexed for MEDLINE]