[Visual acuity following Descemet-membrane endothelial keratoplasty (DMEK): first 100 cases operated on for Fuchs endothelial dystrophy].

Abstract

PURPOSE:

The aim of this study was to evaluate the visual outcome and endothelial cell density in the first series of 100 eyes after Descemet membrane endothelial keratoplasty (DMEK) for the treatment of Fuchs endothelial dystrophy.

DESIGN:

This was a non-randomised prospective clinical trial.

METHODS:

The first 100 consecutive eyes (87 patients) that underwent DMEK (i. e., transplantation of an isolated donor Descemet membrane carrying its endothelium) for Fuchs endothelial dystrophy were evaluated. In all eyes, the best corrected visual acuity (BCVA) as well as the endothelial cell density (ECD) were measured before and at one, three and six months after surgery.

RESULTS:

In eyes with a functional DMEK graft and good visual potential (n = 78), the BCVA was > or = 20 / 40 (> or = 0.5) in 79 % after 1 month, 94 % after 3 months, and 96 % after six months; > or = 20 / 25 (> or = 0.8) in respectively 54 %, 64 %, and 74 %, and > or = 20 / 20 (> or = 1.0) in respectively 26 %, 36 %, and 45 %. In this group, ECD averaged 2630 (+/- 190) cells/mm (2) before, and 1800 (+/- 540) cells/mm (2) at six months after surgery (n = 76). In 15 eyes, a secondary "Descemet stripping endothelial keratoplasty" (DSEK) was performed. When the outcomes of DMEK and secondary DSEK procedures were combined, 91 % reached a BCVA of > or = 20 / 40 (> or = 0.5), 65 % > or = 20 / 25 (> or = 0.8) and 38 % > or = 20 / 25 (> or = 1.0) at six months after surgery (n = 93). For the whole group, ECD averaged 2620 (+/- 190) cells/mm (2) before, and 1730 (+/- 590) cells/mm (2) at six months after surgery (n = 89).

CONCLUSION:

DMEK may provide relatively quick and nearly complete visual rehabilitation in a majority of patients operated on for Fuchs endothelial dystrophy. Endothelial cell survival may be similar to earlier types of endothelial keratoplasty. Early graft detachment (19 cases) was the main complication in this first series of DMEK surgeries.

• Authors: K Droutsas, L Ham, I Dapena, G Geerling, S Oellerich, G Melles
• Journal: Klinische Monatsblatter fur Augenheilkunde (Klin Monbl Augenheilkd) Vol. 227 Issue 6 Pg. 467-77 (Jun 2010) ISSN: 1439-3999 [Electronic] Germany
• Vernacular Title: Visus nach Descemet-Membran Endothelkeratoplastik (DMEK): Ergebnisse der ersten 100 Eingriffe bei Fuchs'scher Endotheldystrophie.
• PMID: 20560100 (Publication Type: Clinical Trial, English Abstract, Journal Article)
• Copyright: Georg Thieme Verlag KG Stuttgart, New York.

Topics

• Adult
• Aged
• Aged, 80 and over
• Descemet Stripping Endothelial Keratoplasty (methods)
• Female
• Fuchs' Endothelial Dystrophy (complications, diagnosis, surgery)
• Humans
• Male
• Middle Aged
• Pilot Projects
• Treatment Outcome
• Vision, Low (diagnosis, etiology, surgery)
• Visual Acuity