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DMEK improves visual acuity but may require more re-bubbling
Ophthalmology. 2011;118(12):2368-2373.
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Descemet's membrane endothelial keratoplasty yielded better visual outcomes than other endothelial keratoplasty techniques but required more re-bubbling, according to a study.
The prospective study included 136 eyes of 112 patients with a mean age of 71 years who underwent DMEK for Fuchs' dystrophy, pseudophakic bullous keratopathy or failed previous graft.
DMEK was performed alone in 110 eyes, in conjunction with phacoemulsification in 23 eyes and in conjunction with pars plana vitrectomy in three eyes. Primary outcome measures were best corrected visual acuity, manifest refraction and endothelial cell density.
Snellen BCVA, manifest refraction and endothelial cell density were assessed preoperatively and 3 months, 6 months and 12 months postoperatively.
Mean preoperative logMAR BCVA was 0.51 (Snellen equivalent 20/65).
At 1 year, mean logMAR postoperative BCVA was 0.07 (Snellen equivalent 20/24). The improvement was statistically significant (P < .001).
Data showed that 41% of patients had BCVA of 20/20 or better, 80% had BCVA of 20/25 or better and 98% had BCVA of 20/30 or better.
One-year data showed an insignificant hyperopic shift of 0.24 D. Astigmatic change was also negligible.
Mean endothelial cell loss was 36% at 1 year. Air re-bubbling rates ranged from 52% to 77%, depending on the surgeon's technique. Eleven grafts failed and required re-grafting.
"Additional and longer-term data on graft survival and endothelial cell loss as well as refinements in technique are needed to identify DMEK's place in the evolution of component corneal transplantation surgery," the authors said.