Clinical Outcomes of Descemet's Membrane Endothelial Keratoplasty: A 1-Year Retrospective Study

Gyu Le Han; Joo Hyun; Dong Hui Lim; Eui Sang Chung; Tae Young Chung

doi:10.3341/jkos.2015.56.10.1489

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Han, Hyun, Lim, Chung, and Chung: Clinical Outcomes of Descemet's Membrane Endothelial Keratoplasty: A 1-Year Retrospective Study

Original Article

J Korean Ophthalmol Soc 2015;56(10):1489-1496.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.10.1489

Clinical Outcomes of Descemet's Membrane Endothelial Keratoplasty: A 1-Year Retrospective Study

Gyu Le Han, M.D, Joo Hyun, M.D, Dong Hui Lim, M.D, Eui Sang Chung, M.D, PhD, Tae Young Chung, M.D, PhD

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Tae Young Chung, MD, PhD Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: 82-2-3410-3564, Fax: 82-2-3410-0029 E-mail: tychung@skku.edu

Received 17 April 20154 June 2015 Accepted 14 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the 1-year results of Descemet's membrane endothelial keratoplasty (DMEK) in Korea.

Methods

The medical records of 9 patients (10 eyes) with endothelial disease who underwent DMEK from January 2012 to December 2013, and were followed up for more than 12 months were reviewed retrospectively.

Results

In 8 eyes with successful results after surgery, best corrective visual acuity (BCVA) was significantly improved from 1.64 ± 0.21 (log MAR, mean) to 0.35 ± 0.22 at 1 month and was maintained at 12 months ( p = 0.012, Wilcoxon signed ranks test). BCVA at postoperative 3, 6 and 12 months were gradually increased (0.25 ± 0.23, 0.20 ± 0.17 and 0.16 ± 0.17 log MAR). Endothelial cell counts were 1,996 ± 528/mm², 1,564 ± 174/mm² and 1,463 ± 541/mm², 1,205 ± 358/mm² at 1, 3, 6, and 12 months after surgery, tended to decrease but showed no statistical significance. There was no statistical difference in astigma-tism before and 3 months after the operation (3.32 ± 2.36 diopter and 2.57± 1.44 diopter). Primary graft failure occurred in 2 eyes and 1 received reoperation. Total detachment was found in 1 eye.

Conclusions

The 1-year results of DMEK showed fast visual recovery which was maintained for 12 months. DMEK may be a very efficient option for the surgical management of corneal endothelial disease.

Keywords: Cornea, DMEK, Endothelial keratoplasty

References

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Figure 1.

Photograph (A) and schematic figure (B) of processed donor cornea. A graft was dissected from the stroma, hinge attached to donor cornea inhibiting graft loss.

Figure 2.

(A) The rolled graft positioned in the cartilage of injector. BSS was filled in rest of the space. (B) Schematic figure of the rolled graft. Graft was rolled with the inner Descemet’s membrane side and outer endothelial side. BSS = balanced salt solution.

Figure 3.

(A) Graft in the anterior chamber. Short burst of BSS rolled the graft upside. (B) Small bubble was injected under the graft. (C) Tapping or scraping the cornea generated turbulent flow. The graft unwrapped between the flow and the bubble. BSS = bal-anced salt solution.

Figure 4.

(A) Air injection under the donor graft. (B) Air bubble pushed the donor graft toward the recipient cornea, inducing graft attachment

Figure 5.

Case 7. A 16 years-old female with early-onset Fuch’s dystrophy. (A) Diffuse corneal edema is observed before DMEK operation. (B) At 1 month after operation, edema is much decreased and the corneal clarity is almost fully restored. DMEK = Descemet's membrane endothelial keratoplasty.

Figure 6.

(A) Anterior segment photo at postoperative day 7 showed partial detachment of Descemet’s membrane graft. (B) Graft de-tachment is also seen on anterior segment OCT at postoperative day 7. (C) Graft detachment decreased but corneal edema remained at postoperative 1 month. (D) Anterior segment OCT taken at posteroperative day 1 month shows decreased graft detachment and a small membrane fold. OCT = optical coherence tomography.

Table 1.

Characteristics of the patients who underwent DMEK operation

Case	Age (years)	Sex	Diagnosis	Preoperative BCVA (log MAR)	Preoperative CCT (μ m)	Combined procedure
1	65	M	PBK	1.70	812
2	79	F	PBK	1.52	704
3	79	F	PBK	1.52	724	Re-operation after primary graft failure
4	46	F	Endothelial de-compensation associated with AC-IOL	1.70	636	PE and PC-IOL
5	73	M	PBK	1.70	843	Macular degeneration
6	58	M	PBK	1.40	715
7	16	F	Fuchs’ dystrophy	2.00	772
8	52	F	Fuchs’ dystrophy	2.00	738	PE and PC-IOL
9	83	M	PBK	1.70	724	Primary graft failure
10	67	M	PBK	1.52	619	Total graft detachment

Mean	58.5 ±	21.04		1.69 ± 0.22	740.89 ± 65.18

Values are presented as mean ± SD unless otherwise indicated. DMEK = Descemet's membrane endothelial keratoplasty; BCVA = best corrected visual acuity; CCT = central corneal thickness; M =male; F = female; PBK = pseudophakic bullous keratopathy; AC-IOL = anterior chamber intraocular lens implantation; PE = phacoe-mulsification; PC-IOL = posterior chamber intraocular lens implantation.

Table 2.

Pre- and postoperative BCVA (log MAR) and CCT

Case^*	Age (years)	Preop BCVA	Postop BCVA				Preop CCT (μ m)	Postop CCT (μ m)
Case^*	Age (years)	Preop BCVA	1 month	3 months	6 months	12 months	Preop CCT (μ m)	6 months	12 months
1	65	1.70	0.22	0.15	0.16	0.10	812	540	543
2	79	1.52	0.15	0.05	0.05	0.05	704	N/D	497
3	79	1.52	0.15	0.05	0.05	0.00	724	512	546
4	46	1.70	0.40	0.40	0.15	0.10	636	N/D	462
5	73	1.70	0.70	0.30	0.30	0.15	843	N/D	N/D
6	58	1.40	0.52	0.22	0.30	0.30	715	555	578
7	16	2.00	0.10	0.05	0.05	0.05	772	458	466
8	52	2.00	0.52	0.70	0.52	0.52	738	490	504
Mean		1.69 ± 0.22	0.35 ± 0.22^†	0.25 ± 0.23	0.20 ± 0.17^‡	0.16 ± 0.17^‡	740.89 ± 65.15	511.00 ± 38.82^†	513.71 ± 43.51

Values are presented as mean ± SD unless otherwise indicated. Case 9 and 10 were excluded. BCVA = best corrective visual acuity; CCT = central corneal thickness; Preop = preoperative; Postop = postoperative; N/D = not done.

^* Case 9 and 10 were excluded;

^† Shows statically significant difference compared to the preoperative value ( p < 0.05, Wilcoxon signed ranks test);

^‡ Shows statically significant difference compared to the postoperative 1 month value ( p < 0.05, Wilcoxon signed ranks test).

Table 3.

Donor and postoperative endothelial cell count (/mm²), refractive error (diopter, D) at 12 months after operation

Case^*	Age (years)	Donor endothelial cell counts	Postop endothelial cell count				Refractive error (D)
Case^*	Age (years)	Donor endothelial cell counts	1 month	3 months	6 months	12 months	Spherical	Cylinder
1	65	2,844	2,129	1,675	1,024	1,113	+1.25	-1.0
2	79	2,849	N/D	1,461	N/D	1,098	-0.25	-1.5
3	79	2,756	N/D	1,326	1,326	692	0.0	-0.75
4	46	2,985	N/D	1,492	N/D	1,354	-2.75	-2.25
5	73	2,545	1,818	1,818	N/D	1,828	-2.25	-1.0
6	58	2,545	1,392	1,614	957	929	+1.75	-2.5
7	16	3,300	2,645	N/D	2,250	1,082	-1.0	-0.5
8	52	2,915	N/D	N/D	1,759	1,543	-3.5	-0.5
Mean		2,842 ± 245	1,996 ± 528	1,564 ± 174	1,463 ± 541	1,205 ± 358

Values are presented as mean ± SD unless otherwise indicated. Case 9 and 10 were excluded. Postop = postoperative; N/D = not done.

^* Case 9 and 10 were excluded.

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