Elsevier

Ophthalmology

Volume 118, Issue 11, November 2011, Pages 2147-2154
Ophthalmology

Original article
Learning Curve in Descemet's Membrane Endothelial Keratoplasty: First Series of 135 Consecutive Cases

https://doi.org/10.1016/j.ophtha.2011.03.037Get rights and content

Purpose

To evaluate the learning curve in Descemet's membrane endothelial keratoplasty (DMEK) in the management of corneal endothelial disorders.

Design

Retrospective, nonrandomized, clinical study at a tertiary referral center.

Participants

We included 135 eyes of 118 patients with Fuchs' endothelial dystrophy.

Methods

In a first group of 135 consecutive eyes, a DMEK was performed. To determine the extent of a possible learning curve in DMEK surgery, the whole group was divided into 3 subgroups of 45 patients, to compare clinical outcomes at 1, 3, and 6 months.

Main Outcome Measures

Best-corrected visual acuity (BCVA), endothelial cell density (ECD), and intra- and postoperative complications.

Results

Among the 3 groups clinical outcomes were similar, with 73% of cases achieving a BCVA of ≥20/25 (≥0.8) and an average ECD of 1747±527 cells/mm2, at 6 months. Graft detachment was the main complication and correlated with intraoperative vitreous pressure (P<0.01). The detachment rate declined with experience: In the first 45 cases, a complete or partial graft detachment occurred in 20%, in the second group in 13.3%, and in the third group in 4.4%. Other complications were relatively uncommon: Failure to unfold or position the graft during surgery (0.7%), intraocular hemorrhage (0.7%), primary graft failure (2.2%), air-bubble induced angle closure glaucoma (3%), remnant host Descemet's at the interface (5.9%), and cystoid macular edema (0.7%). Surgeries (partially) performed by an inexperienced surgeon showed a similar clinical outcome and complication rate.

Conclusions

The learning curve in DMEK did not correlate with clinical outcome (BCVA and ECD), but rather to the presence of a functional graft. However, the number of functional grafts (decline in graft detachment rate) increased with surgical experience.

Financial Disclosure(s)

Proprietary or commercial disclosures may be found after the references.

Section snippets

Materials and Methods

In a first group of 135 consecutive eyes of 118 patients, with Fuchs' endothelial dystrophy, 49 male and 69 female, ranging from 33 to 93 years in age (average, 67.2±11.9), a DMEK procedure11, 12, 13, 14 was performed. Twenty-one eyes were phakic; all other eyes pseudophakic. All patients signed an institutional review board-approved clinical research informed consent. All DMEK surgeries were (partially) performed by a single surgeon (G.M.; 115 eyes) or a corneal fellow (I.D., K.M., or K.D.; 20

Results

To evaluate the learning curve in DMEK surgery, a total of 135 consecutive eyes that enrolled in our study were retrospectively divided in 3 groups of 45 patients (groups I–III; Table 1) for analysis and comparison. The BCVA and ECD were considered as the clinically most significant outcome parameters. The feasibility of the technique in time may be reflected by the intra- and postoperative complications, as well as by the number of secondary interventions required to obtain a clinically

Discussion

In the current study, the learning curve in DMEK was evaluated in a first series of 135 patients.

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  • Cited by (0)

    Manuscript no. 2010-431.

    Financial Disclosure(s): The authors have made the following disclosures:

    Gerrit Melles – Consultant – D.O.R.C./Dutch Ophthalmic USA.

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