Descemet membrane endothelial keratoplasty (DMEK): clinical results of precut versus surgeon-cut grafts
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Descemet membrane endothelial keratoplasty (DMEK): clinical results of precut versus surgeon-cut grafts Doreen Koechel 1 & Nicola Hofmann 2 & Jan D. Unterlauft 1 & Peter Wiedemann 1 & Christian Girbardt 1 Received: 24 April 2020 / Revised: 10 August 2020 / Accepted: 16 August 2020 # The Author(s) 2020
Abstract Purpose This study aims to investigate possible differences in clinical outcomes between precut and surgeon-cut grafts for Descemet membrane endothelial keratoplasty (DMEK). Methods 142 consecutive patients who underwent DMEK were included in the study. 44 patients received precut tissues, and 98 patients received surgeon-cut tissues. Precut grafts were allocated to the patient by the German Society for Tissue Transplantation if available. We compared the outcomes of both groups for changes in visual acuity, central corneal thickness, endothelial cell density, re-bubbling rate, and graft failure rate. Results Patients who received precut tissues experienced similar increase in visual acuity (median change 0.4 logMAR) and decrease of corneal swelling (median change 132 μm) compared with those who received surgeon-cut tissues (median VA change 0.3 logMAR, p = 0.55, CCT change 118 μm, p = 0.63). There was no statistical difference in endothelial cell density (1436 vs. 1569 cells/mm2, p = 0.37), re-bubbling (32% vs. 35%, p = 0.85), and graft failure rate (5% vs. 1%, p = 0.23). No primary graft failure occurred in the group of precut grafts. Conclusion Both methods lead to comparable results for visual acuity, corneal deswelling, endothelial cell density, and re-bubbling rate. A previously described higher graft failure rate for precut tissues could not be confirmed in our study. Thus, we do not see medical reasons against the use of precut tissues. There are several advantages of precut DMEK tissues over surgeon-cut tissues, especially the prevention of graft loss during preparation in the operating theater. Keywords Descemet membrane endothelial keratoplasty . Precut tissue . Corneal transplantation . Eye bank
Introduction Since its first description by Melles [1] in 2006, the overwhelming success of Descemet membrane endothelial keratoplasty (DMEK) has helped many patients with corneal endothelial disorders to obtain better vision and increased quality of life. DMEK consists of stripping off Descemet’s membrane with the adherent endothelium from a donor eye and transferring it as a roll into the anterior chamber of the patient’s eye subsequent to the removal of that eye’s * Doreen Koechel [email protected] 1
Dept. of Ophthalmology, University Hospital Leipzig, Liebigstraße 10-14, 04103 Leipzig, Germany
2
German Society for Tissue Transplantation, Feodor-Lynen-Straße 21, 30625 Hannover, Germany
Descemet’s membrane. The graft is then unfolded and fixed by an air or gas bubble. Besides graft unfolding, the most challenging step is graft preparation directly before the operation. Therefore, the idea of preparing the graft as much as possible in the tissue bank was developed [2]. The aim of these pr
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