J Korean Ophthalmol Soc.  2015 Oct;56(10):1489-1496. 10.3341/jkos.2015.56.10.1489.

Clinical Outcomes of Descemet's Membrane Endothelial Keratoplasty: A 1-Year Retrospective Study

• Han GL
• Hyun J
• Lim DH
• Chung ES
• Chung TY

• KMID: 2214406
• DOI: http://doi.org/10.3341/jkos.2015.56.10.1489

Abstract

PURPOSE
To evaluate the 1-year results of Descemet's membrane endothelial keratoplasty (DMEK) in Korea.
METHODS
The medical records of 9 patients (10 eyes) with endothelial disease who underwent DMEK from January 2012 to December 2013, and were followed up for more than 12 months were reviewed retrospectively.
RESULTS
In 8 eyes with successful results after surgery, best corrective visual acuity (BCVA) was significantly improved from 1.64 +/- 0.21 (log MAR, mean) to 0.35 +/- 0.22 at 1 month and was maintained at 12 months (p = 0.012, Wilcoxon signed ranks test). BCVA at postoperative 3, 6 and 12 months were gradually increased (0.25 +/- 0.23, 0.20 +/- 0.17 and 0.16 +/- 0.17 log MAR). Endothelial cell counts were 1,996 +/- 528/mm2, 1,564 +/- 174/mm2 and 1,463 +/- 541/mm2, 1,205 +/- 358/mm2 at 1, 3, 6, and 12 months after surgery, tended to decrease but showed no statistical significance. There was no statistical difference in astigmatism before and 3 months after the operation (3.32 +/- 2.36 diopter and 2.57+/- 1.44 diopter). Primary graft failure occurred in 2 eyes and 1 received reoperation. Total detachment was found in 1 eye.
CONCLUSIONS
The 1-year results of DMEK showed fast visual recovery which was maintained for 12 months. DMEK may be a very efficient option for the surgical management of corneal endothelial disease.

Keyword

Cornea; DMEK; Endothelial keratoplasty

MeSH Terms

Astigmatism
Cornea
Corneal Transplantation*
Descemet Membrane*
Endothelial Cells
Humans
Korea
Medical Records
Reoperation
Retrospective Studies*
Transplants
Visual Acuity

Figure

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  Figure 1. Photograph (A) and schematic figure (B) of processed donor cornea. A graft was dissected from the stroma, hinge attached to donor cornea inhibiting graft loss.

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  Figure 2. (A) The rolled graft positioned in the cartilage of injector. BSS was filled in rest of the space. (B) Schematic figure of the rolled graft. Graft was rolled with the inner Descemet’s membrane side and outer endothelial side. BSS = balanced salt solution.

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  Figure 3. (A) Graft in the anterior chamber. Short burst of BSS rolled the graft upside. (B) Small bubble was injected under the graft. (C) Tapping or scraping the cornea generated turbulent flow. The graft unwrapped between the flow and the bubble. BSS = bal-anced salt solution.

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  Figure 4. (A) Air injection under the donor graft. (B) Air bubble pushed the donor graft toward the recipient cornea, inducing graft attachment

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  Figure 5. Case 7. A 16 years-old female with early-onset Fuch’s dystrophy. (A) Diffuse corneal edema is observed before DMEK operation. (B) At 1 month after operation, edema is much decreased and the corneal clarity is almost fully restored. DMEK = Descemet's membrane endothelial keratoplasty.

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  Figure 6. (A) Anterior segment photo at postoperative day 7 showed partial detachment of Descemet’s membrane graft. (B) Graft de-tachment is also seen on anterior segment OCT at postoperative day 7. (C) Graft detachment decreased but corneal edema remained at postoperative 1 month. (D) Anterior segment OCT taken at posteroperative day 1 month shows decreased graft detachment and a small membrane fold. OCT = optical coherence tomography.

Reference

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