Two-year outcomes show strengths, weaknesses of quarter-DMEK
PARIS — Two years of follow-up with quarter-Descemet’s membrane endothelial keratoplasty show visual outcomes comparable to those of conventional DMEK surgery and no graft rejection or secondary failure, but the decrease in endothelial cell density calls for further enhancement of the technique, according to a speaker at a NIIOS presentation during EuCornea 2019.
“Quarter-DMEK, in which only a quarter of a DMEK graft is implanted, seems the best option for patients who only have mild gutta centrally and good peripheral cells,” Diana Dragnea, MD, cornea fellow at the Netherlands Institute for Innovative Ocular Surgery (NIIOS), said.
The procedure is similar to DMEK, with a slightly smaller descemetorhexis of 6 mm to 7 mm. After injecting the quarter graft, the surgeon must make sure that it is correctly positioned in the center, covering the pupillary area.
“We have now 19 patients with 1 to 2 years’ follow-up. They seem to do well. BCVA is comparable to DMEK and hemi-DMEK,” Dragnea said.
However, endothelial cell density at 6 months was significantly decreased in 68% of the eyes. Corneal clearance was complete in 60% of the eyes, while 37% had central corneal clearance but persistent edema, mostly in the area of the round edge of the graft. No graft rejection or secondary graft failure occurred.
“Smaller grafts mean more availability of the tissue and maybe less rejection. The decrease in endothelial cell density is something we have to work on, but we think that by keeping healthy peripheral cells we might have some positive influence on the survival rate in the longer term,” Dragnea said. – by Michela Cimberle
Disclosure: Dragnea reports no relevant financial disclosures.