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Learning curve has impact on graft detachment rate in DMEK
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 Isabel Dapena |
ISTANBUL, Turkey — The learning curve in Descemet's membrane endothelial keratoplasty has an impact on the rate of graft detachment, according to a study conducted by a pioneer of the technique, Gerrit Melles, MD, and colleagues.
The first series of 135 patients undergoing Descemet's membrane endothelial keratoplasty (DMEK) was divided into three consecutive subgroups of 45 patients to compare best corrected visual acuity and endothelial cell count at 1, 3 and 6 months. Intraoperative and postoperative complications and the impact of the learning curve were also measured.
"Clinical outcomes were similar in the three groups, with 73% of the patients achieving BCVA of 20/25 or better," study team member Isabel Dapena, MD, said at the winter meeting of the European Society of Cataract and Refractive Surgeons. "Endothelial cell density (1755 cells/mm² ± 526 cells/mm²) was also similar after 6 months."
However, a significant difference was reported in the rate of complications, particularly graft detachment. In the first 45 cases, a complete or partial graft detachment occurred in 20% of patients; complete or partial detachment occurred in 13.3% of the second group and only 4.4% of the last group.
"DMEK is a technically demanding procedure, and a difference in learning curve-related outcomes was to be expected. However, other complications, such as failure to unfold or position the graft during surgery or primary graft failure, were much less frequent than it is commonly thought, at all points of the learning curve," Dr. Dapena said.
- Disclosure: Dr. Dapena has no direct financial interest in the products discussed in this article, nor is she a paid consultant for any companies mentioned.