DMEK yields fast visual recovery for endothelial dysfunction

Issue: November/December 2014

CHICAGO — Six-year midterm results showed Descemet’s membrane endothelial keratoplasty for the treatment of endothelial dysfunction provides fast and potentially complete visual recovery, a speaker said here.

Perspective from Parag A. Majmudar, MD

“With our cohort, visual acuity improvements were quite impressive, and by 6 months, more than 95% of patients achieved 20/40 vision,” Fook Chang Lam, MBChB, MRCP, FRCOphth, said at the American Academy of Ophthalmology meeting.

Fook Chang Lam

Descemet’s membrane endothelial keratoplasty (DMEK) was performed in 300 eyes for the treatment of endothelial dysfunction and was successful in 86% of eyes; 41 eyes required re-transplantation. Graft failure occurred in eight eyes, and detachment occurred in 33 eyes.

“Although some of these patients cleared in the short term without any bubbling procedures, in the longer term, some of these patients subsequently needed a re-transplant,” Lam said.

Complications included air bubble dislocation, steroid induced ocular hypertension and secondary glaucoma.

“Several patients had intraocular problems, but only 1.3% developed secondary glaucoma,” Lam said.

According to Lam, endothelial cell density decreased at a steady rate after the first 6 months, and complications were rare after the first 6 months.

Disclosure: Lam has no relevant financial disclosures.

Perspective

Parag A. Majmudar, MD

DMEK is quickly becoming a go-to procedure for corneal specialists. Although it has its origins more than 8 years ago in Europe and elsewhere, several hurdles have prevented it from becoming mainstream here in the U.S. Now that we are seeing some of those barriers starting to be overcome, it is wonderful to see such long-term results of DMEK. This will go a long way toward encouraging U.S. surgeons to develop the skills required for this intricate procedure. Having performed this procedure for the past 18 months, I can vouch for its remarkable impact on patients’ lives. I liken it to the “wow” factor that we saw with LASIK in the late 1990s. I cannot tell you how many of my DMEK patients tell me, without solicitation, that their quality of vision is the best it has been in decades. I believe that we are going to see greater numbers of DMEK being performed in this country and results such as these will undoubtedly stimulate the growth of DMEK.

Parag A. Majmudar, MD

Chicago Cornea Consultants

Highland Park, Ill.

Disclosures: Majmudar has no relevant financial disclosures.