BELGRADE, Serbia — A multicenter study on Descemet’s membrane endothelial keratoplasty showed that results improve with experience, but beginner surgeons can also achieve good clinical outcomes.
“Up to now, we only had single-center studies on DMEK. We set up the first multicenter study, including the data from 55 surgeons in 33 countries and comparing the results of beginners and experienced DMEK surgeons,” Jorge Peraza-Nieves, MD, said at the European Society of Cataract and Refractive Surgeons winter meeting.
Seventy percent of the surgeons included were Europeans, mostly trained at the NIIOS center in Rotterdam, Netherlands. A total of 2,485 eyes were analyzed, most of which had Fuchs’ dystrophy. Best corrected visual acuity, endothelial cell count and complication rate up to 6 months were evaluated.
“We divided the eyes in three groups, according to surgeon’s experience of less than 25 surgeries, between 25 and 99 surgeries, and more than 100 surgeries,” Peraza-Nieves said.
The graft was prepared by the surgeon in 72% of the cases, with 60% prepared directly before the surgery. Graft diameter was mostly between 8 mm and 9 mm. DMEK only was performed in 78% of the eyes and was combined with cataract surgery in 17% of the eyes.
Visual acuity improved in 90.5% of the eyes, with 75% achieving 20/40 or better.
The visual acuity results were similar in the three groups and slightly better in eyes operated by experienced surgeons. Intraoperative complications ranged from 16% in the beginner surgeons’ group to 5% in the experienced surgeons’ group. Postoperative complications, mainly graft detachment, varied from 34% to 22%, also according to experience. Increased IOP, graft failure and graft rejection were independent from experience. Secondary interventions significantly decreased according to experience and were mainly correlated with detachment rate.
“We were able to confirm that DMEK is a successful procedure. It has a learning curve, but novel surgeons, if properly trained, should be confident that good results can be achieved,” Peraza-Nieves said. – by Michela Cimberle
Peraza-Nieves J, et al. Multicenter study on Descemet membrane endothelial keratoplasty (DMEK). Presented at European Society of Cataract and Refractive Surgeons winter meeting; Feb. 9-11, 2018; Belgrade, Serbia.
Disclosure: Peraza-Nieves reports no relevant financial disclosures.