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Overall clinical outcomes of Descemet membrane endothelial keratoplasty in 600 consecutive eyes: A large retrospective case series
- Source :
- Indian Journal of Ophthalmology, Vol 68, Iss 6, Pp 1044-1053 (2020)
- Publication Year :
- 2020
-
Abstract
- Purpose: To analyze the overall clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in 600 consecutive cases. Methods: Retrospective, consecutive interventional case series operated by a single surgeon. Six hundred consecutive eyes of 524 patients with endothelial dysfunctions of different etiologies scheduled for DMEK were included in this study. All donor tissues were prepared by the operating surgeon during the procedure, using McCarey Kaufman medium or Cornisol-preserved cornea with endothelial cell density (ECD) of ≥2500 cells/mm2. Indications, postoperative best spectacle-corrected visual acuity (BSCVA), ECD, endothelial cell loss (ECL), and complications were analyzed postoperatively between 3 months and 2 years. Results: The commonest indication was post-cataract corneal edema/bullous keratopathy in 262 (43.7%) eyes followed by Fuchs' endothelial corneal dystrophy 218 (36.3%). Vision affected comorbidities were present in 91 (15.2%) eyes. In phakic eyes with cataract (222; 37%), DMEK was combined with cataract surgery (Triple-DMEK). BSCVA of ≥20/25 was achieved in 41.0%, 46.4%, 49.2%, and 48.7% of eyes at 3, 6, 12, and 24 months, respectively and stabilized at 6 months (P = 0.54). Mean ECD decreased from 2884 ± 178 cells/mm2 (n = 600) before surgery to 2223 ± 321 (n = 597), 2099 ± 354 (n = 524), 1918 ± 373 (n = 374), and 1772 ± 439 cells/mm2 (n = 158) at 3, 6, 12, and 24 months respectively. The corresponding mean ECL was 22.9 ± 11.4%, 27.2 ± 12.4%, 33.5 ± 13.0%, and 38.6 ± 14.3%, respectively (P < 0.05 for all-time points). The commonest complication was DM detachment in 59 (9.8%) eyes of which 23 (3.8%) eyes required rebubbling. Three (0.5%) eyes had primary graft failure. Endothelial rejection occurred in 7 (1.2%) eyes until the last follow-up. Conclusion: DMEK is a safe and effective procedure in different types of endothelial diseases with encouraging surgical and clinical outcomes. Complications are less and ECL percentage up to 2 years is acceptable.
- Subjects :
- medicine.medical_specialty
Visual acuity
genetic structures
Descemet membrane
medicine.medical_treatment
Visual Acuity
Cell Count
McCarey-Kaufman medium
03 medical and health sciences
0302 clinical medicine
lcsh:Ophthalmology
Ophthalmology
Cornea
surgeon's prepared donor tissue
medicine
Humans
descemet membrane endothelial keratoplasty
Descemet Membrane
Retrospective Studies
business.industry
visual outcomes
endothelial cell density
endothelial cell loss
Endothelium, Corneal
Fuchs' Endothelial Dystrophy
Cataract surgery
Corneal Endothelial Cell Loss
eye diseases
Single surgeon
Endothelial cell density
medicine.anatomical_structure
lcsh:RE1-994
030221 ophthalmology & optometry
Bullous keratopathy
sense organs
medicine.symptom
business
030217 neurology & neurosurgery
Descemet Stripping Endothelial Keratoplasty
Subjects
Details
- ISSN :
- 19983689
- Volume :
- 68
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Indian journal of ophthalmology
- Accession number :
- edsair.doi.dedup.....aa835d54ceceebe27aef69a58b368913