Near complete visual recovery and refractive stability in modern corneal transplantation: Descemet membrane endothelial keratoplasty (DMEK)

ObjectiveTo report the 6 months results of a large prospective study on Descemet membrane endothelial keratoplasty (DMEK) for management of corneal endothelial disorders.MethodsDMEK was performed in 300 consecutive eyes with Fuchs endothelial dystrophy, bullous keratopathy or previous corneal transplant failure. Best spectacle corrected visual acuity (BSCVA), refractive outcome and endothelial cell density (ECD) were evaluated before and at 1, 3, and 6 months after surgery. Intra- and postoperative complications were documented.ResultsAt 6 months, 98% of eyes reached a BCVA of ≥20/40 (≥0.5), 79% ≥20/25 (≥0.8), 46% ≥20/20 (≥1.0), and 14% ≥20/18 (≥1.2) (n = 221). The pre- to 6 months postoperative spherical equivalent (SE) showed a +0.33D (±1.08D) hyperopic shift (P = 0.0000). Refractive stability was shown at 3 months after DMEK, i.e. no significant change in SE (P = 0.0822) or refractive cylinder (P = 0.6182) at 3 versus 6 months follow-up. Donor ECD showed a decrease from 2561 (±198) cells/mm2 before, to 1674 (±518) cells/mm2 at 6 months after surgery (n = 251) (P = 0.0000). The main complication was (partial) graft detachment occurring in 31 eyes (10%). Secondary ocular hypertension was seen in 13 eyes (6%): 6 induced by air-bubble dislocation posterior to the iris and 4 induced by steroids. Secondary cataract requiring phaco-emulsification developed in 3 out of 63 (5%) phakic eyes.ConclusionsDMEK may provide a refractively neutral near complete, rapid visual rehabilitation with ECDs similar to earlier endothelial keratoplasty techniques. This combined with a relatively low complication rate, would indicate that DMEK is a safe and effective treatment for corneal endothelial disorders.