Descemet membrane endothelial keratoplasty (DMEK): intraoperative and postoperative complications and clinical results

Queratoplastia endotelial da membrana de Descemet (DMEK): complicações intraoperatórias e pós-operatórias com resultados clínicos

ABSTRACT

Purpose:  To evaluate the complications and clinical results of Descemet membrane endothelial keratoplasty (DMEK) in patients with endothelial failure that occurred during the learning curve of a surgeon.

Methods:  Fifty eyes of 50 patients with DMEK and ≥6 months of follow-up were included. The patients were divided into the first 25 (group 1) and the second 25 (group 2) procedures performed by the surgeon. Best corrected visual acuity (BCVA), central corneal thickness (CCT), unfolding time of the Descemet membrane (DM) graft, and intraoperative and postoperative complications were compared between groups.

Results:  The differences in postoperative increase of BCVA (p=0.595) and decrease of CCT (p=0.725) in the two groups were not significant. The unfolding time of the DM was longer in group 1 than in group 2 (p=0.001). Primary graft failure occurred in three patients in group 1 and none in group 2. At the last visit, 42 (85.7%) of patients’ corneas were clear, with significant difference between groups (p=0.584). A patient in group 1 with a history of pars plana vitrectomy, inferior iridectomy, and fluid as a tamponade experienced drop of the DM graft into the iridectomy space. All other intraoperative complications occurred in group 1.

Conclusions:  Occurrence of intraoperative and postoperative complications was increased in patients with coexisting ocular pathology or complicated endothelial dysfunction and during the surgeon’s learning curve of DM endothelial keratoplasty procedures.

Keywords: Descemet membrane; Corneal disease/surgery; Descemet stripping endothelial keratoplasty; Intraoperative complications; Postoperative complications