To assess the evolution of clinical outcomes of more than 1300 Descemet membrane endothelial keratoplasties (DMEKs) alone or in combination with cataract surgery (triple DMEK) throughout a 5-year ...period at a single center, performed by 2 already experienced DMEK surgeons.
Retrospective trend study.
Review of charts between July 2011 and July 2016 at the Department of Ophthalmology, University of Cologne, Germany.
A total of 1340 out of 1340 eyes with sufficient information were included. Six-month and 12-month best spectacle-corrected visual acuity (logMAR) had already reached high levels for the surgeries performed in 2011 (0.10 ± 0.06 and 0.09 ± 0.07, respectively) and did not further improve in later years (P = .272). Likewise, endothelial cell loss (ECL) and central corneal thickness (CCT) reached comparable levels independently of the year of surgery (average 12-month ECL was 38% ± 15% and average 6-month CCT decrease was 19% ± 11%). However, there was a decrease in the rebubbling rate, from 68% in 2011, 67% in 2012, and 70% in 2013 to 53% in 2014, 29% in 2015, and 16% in 2016, which was associated with the introduction of 20% sulfur hexafluoride (SF6) instead of room air for anterior chamber tamponade in 2015 (n = 986; P < .001). The percentage of severe complications after DMEK surgery also decreased significantly with surgeons' growing experience (P < .001; 95% confidence interval 0.09; 0.12) over the years.
After an initial learning curve in DMEK surgery, results of visual acuity and ECL do not seem to further improve. However, the complication rate continuously declines, at least over the subsequent 5-year period analyzed herein.
This study aimed to identify the risk factors for endothelial cell density (ECD) loss after Descemet membrane endothelial keratoplasty (DMEK) and analyse whether donor tissues from cold versus organ ...culture differ in terms of ECD loss after DMEK. Consecutive DMEK cases from a prospective database for Fuchs' endothelial corneal dystrophy were retrospectively analysed between 2011 and 2016 at the University of Cologne, and the possible risk factors for ECD loss, including patient-related factors, type of tamponade (air or 20% sulphur hexafluoride gas), type of surgery (triple DMEK or DMEK alone), re-bubbling, immune rejection, and donor-related factors were determined. Eight hundred and forty-one eyes were selected. There was no significant difference in the best-corrected visual acuity (logarithm of the minimal angle of resolution) and corneal thickness (P = 0.540 and P = 0.667) between groups. Immune reactions were more common in cold cultures (P = 0.019), but ECD loss (1 year after DMEK) was greater in organ cultures (38.3 ± 0.8%) than in cold cultures (34.7 ± 1.4%) (P = 0.022). Only re-bubbling was significantly associated with ECD loss (P < 0.001). Re-bubbling was found to be a key factor for ECD loss at 1 year after DMEK.
Abstract Purpose To identify incidence of and risk factors for calcifications of intraocular lenses (IOLs) after Descemet membrane endothelial keratoplasty (DMEK). Design Retrospective cohort study. ...Methods Retrospective review of charts and slit-lamp images of 564 consecutive patients from the prospective Cologne DMEK database who underwent DMEK in pseudophacic eyes or DMEK in combination with cataract surgery (triple-DMEK) between 09/2013 and 10/2015 at the Department of Ophthalmology, University of Cologne. Results IOL calcifications after (triple-) DMEK occurred in 14 patients (2.5%). Visual acuities in affected and unaffected eyes were 0.33±0.24 logMAR and 0.16±0.01 logMAR after 3 months (p<0.001) as well as 0.28±0.16 logMAR and 0.13±0.08 logMAR (p<0.001) after 6 months, respectively. The proportions of triple-DMEK vs. DMEK, the use of SF6 gas vs. room air for anterior chamber tamponade and the presence of hydrophilic vs. hydrophobic acrylic IOLs were comparable in affected and unaffected eyes. Patients with IOL calcifications had higher re-bubbling rates than patients without. Larger pupil diameters at the time of surgery showed a tendency to slightly larger areas of IOL calcifications. Conclusions IOL calcifications after anterior chamber gas tamponade in DMEK lead to visual impairment and are associated with the number of re-bubblings after DMEK. IOL calcifications also occur in hydrophobic acrylic IOLs.
Purpose
To assess the effect of donor tissue diameter in Descemet Membrane Endothelial Keratoplasty (DMEK) on postoperative endothelial cell density (ECD) mainly in Fuchs Endothelial Corneal ...Dystrophy (FECD) patients.
Methods
Retrospective review of 693 consecutive DMEK surgeries from the prospective Cologne DMEK database performed between 07/2011 and 07/2016 at the Department of Ophthalmology, University of Cologne. Eight‐ versus ten‐millimetre large donor DMEK grafts of two different surgeons using identical surgical techniques were compared.
Results
A total of 693 consecutive DMEK surgeries were included. Two groups (8 versus 10 mm DMEK graft diameter) were compared: 23% of eyes received 8‐mm grafts (group 1, n = 160) and 77% 10‐mm grafts (group 2, n = 533). Mean preoperative ECD (±SD) of donor tissue was 2736 ± 224 cells/mm2 in group 1 and 2714 ± 232 in group 2. Group 1 showed a mean ECD of 1740 ± 439 cells/mm2 (mean ± SD; n = 67) 12 months after DMEK compared to 1664 ± 404 cells/mm2 (mean ± SD; n = 344) in group 2. The difference between the 6‐ and 12‐month ECD of both groups was not significant (p = 0.675; p = 0.161). Total decrease in ECD 6‐ and 12‐months postoperatively was 38 ± 14 (n = 128) and 36 ± 16% in group 1 (n = 66) versus 37 ± 15% (n = 398) and 38 ± 15% in group 2 (n = 342; p = 0.414; p = 0.198, respectively).
Conclusion
Our data suggest that postoperative central endothelial cell density is not significantly associated with DMEK graft diameters in the range of 8–10 mm in cases with healthy peripheral host endothelium (such as FECD).
Purpose
This study aims to assess the results, rebubbling rate, and graft survival after Descemet membrane endothelial keratoplasty (DMEK) with regard to the number and type of previous glaucoma ...surgeries.
Methods
This is a clinical retrospective review of 1845 consecutive DMEK surgeries between 07/2011 and 08/2017 at the Department of Ophthalmology, University of Cologne. Sixty-six eyes were included: group 1 (eyes with previous glaucoma drainage devices (GDD);
n
= 27) and group 2 (eyes with previous trabeculectomy (TE);
n
= 39). Endothelial cell loss (ECL), central corneal thickness, graft failure, rebubbling rate, and best spectacle-corrected visual acuity (BSCVA) up to 3 years after DMEK were compared between subgroups of patients with different numbers of and the two most common types of glaucoma surgeries either GDD or TE or both.
Results
Re-DMEK rate due to secondary graft failure was 55.6% (15/27) in group 1 and 35.9% in group 2. The mean graft survival time in group 1 was 25 ± 11 months and 31.3 ± 8.6 months in group 2 (
p
= 0.009).
ECL in surviving grafts in group 1 was 35% (
n
= 13) at 6 months, 36% at 12 months (
n
= 8), and 27% (
n
= 4) at 2 years postoperatively. In group 2, ECL in surviving grafts was 41% (
n
= 10) at 6 months, 36% (
n
= 9) at 12 months, and 38% (
n
= 8) at 2 years postoperatively. Rebubbling rate in group 1 was 18.5% (5/27) and 35.9% (14/39) in group 2 (
p
= 0.079).
Conclusion
Eyes with previous GDD had no higher risk for an increased rebubbling rate but a higher risk for a re-DMEK due to secondary graft failure with a mean transplant survival time of about 2 years. Compared to eyes with preexisting glaucoma drainage device, eyes after trabeculectomy had less secondary graft failures and a longer mean graft survival rate.
Purpose
To assess the long‐term outcome of Descemet membrane endothelial keratoplasty (DMEK) following failed penetrating keratoplasty (PK).
Methods
Retrospective review of 1840 consecutive DMEK ...surgeries from the prospective Cologne DMEK database performed between 07/2011 and 08/2017 at the Department of Ophthalmology, University of Cologne.
Results
Fifty‐two eyes received a DMEK surgery after failed PK. Main indications for initial PK were Fuchs endothelial corneal dystrophy (23.1%), keratoconus and herpetic keratitis (each 15.4%). Best‐corrected visual acuity (BCVA) at 3, 6 and 12 months was 0.72 ± 0.39 (n = 33), 0.56 ± 0.36 (n = 32) and 0.38 ± 0.28 (n = 23), respectively. Two‐ and 3‐year BCVA was 0.37 ± 0.21 (n = 21) and 0.32 ± 0.18 (n = 10). Mean improvement in visual outcome in logMAR lines was +4.3 ± 3.4 at 6 months, +5.0 ± 3.6 at 12 months, +6.0 ± 2.3 at 24 months and +5.4 ± 2.7 at 36 months, respectively. 59.6% received at least one rebubbling and 40.4% did not necessitate a rebubbling. Endothelial cell density (ECD)‐decrease at 6 months was 36% (n = 17), 37% at 12 months (n = 17), 40% at 2 years (n = 8) and 32% at 3 years (n = 2). 34.6% of transplants needed a regraft.
Conclusion
Descemet membrane endothelial keratoplasty (DMEK) is a feasible treatment option after failed PK having a relatively good long‐term outcome.
Purpose
To evaluate whether and how preoperative visual acuity predicts visual acuity outcome after Descemet Membrane Endothelial Keratoplasty (DMEK).
Methods
One thousand eighty-four out of 1162 ...consecutive eyes having undergone DMEK alone or combined with cataract surgery (triple-DMEK) between July 2011 and February 2016 from the prospective Cologne DMEK database were included and analyzed retrospectively for correlations between pre- and postoperative visual acuity values at 1, 3, 6, and 12 months after transplantation.
Results
There is a significant correlation between pre- and postoperative visual acuity (VA) after (triple)-DMEK after 6 and 12 months (
p
= 0.005 and
p
= 0.011 respectively; Pearson’s correlation coefficient 0.240 and 0.224). Preoperative VA below 20/100 leads to delayed and reduced final visual acuity results after 12 months (
p
< 0.001). However, defining an increase in VA > 0.1 logMAR as clinically relevant, we could not show any clinically relevant significant difference in the time needed to recover to final VA and in final VA. There is no significant difference for preoperative VA values above 20/40. The chance to reach postoperative VA above 20/25 is 40% for preoperative VA of 20/200, 50% for preoperative VA of 20/60 and > 60% for preoperative VA of 20/40.
Conclusion
DMEK results in very good final postoperative visual acuity results even in eyes with very poor preoperative vision caused by corneal pathology. However, preoperative visual acuity values below 20/100 result in significantly poorer visual recovery, which suggests that there is benefit in performing surgery early enough before this value is reached. Preoperative visual acuity seems to be an adjuvant tool for the prediction of the final visual outcome after DMEK.
Abstract
Background
Patients undergoing corneal abrasion as part of Descemet membrane endothelial keratoplasty (DMEK) under general anesthesia suffer from early burning pain postoperatively. This ...pain appears to be poorly treatable with systemic analgesics. This study aims to evaluate postoperative pain management using topical lidocaine gel after DMEK with iatrogenic corneal abrasion.
Methods
Retrospective analysis of 28 consecutive patients undergoing DMEK with corneal abrasion from October 19, 2021, to November 12, 2021, at a German university hospital. Patients during week 1 and 2 received peri-operative standard pain treatment (cohort S) and additional local lidocaine gel during week 3 and 4 immediately postoperatively (cohort L).
Results
13 patients were included in cohort S and 15 patients in cohort L. At awakening all patients (100%) in cohort S reported burning pain, and six of 15 patients (40%) in cohort L reported burning pain. Burning pain scores were significantly lower in cohort L (p < 0.001 at awakening, p < 0.001 at 10 min, p < 0.001 at 20 min, p < 0.001 at 30 min, p = 0.007 at 40 min after awakening, and p < 0.001 at leaving recovery room). No significant differences between cohort S and cohort L were detected concerning surgical outcome during 1-month-follow-up (p = 0.901 for best corrected visual acuity).
Conclusion
Patients undergoing DMEK with corneal abrasion suffer significant pain in the recovery room. A single dose of topic lidocaine gel reduces the early postoperative burning pain sufficiently and does not affect the surgical outcome.
Descemet membrane endothelial keratoplasty (DMEK) has evolved into a routine surgical procedure for posterior lamellar keratoplasty. After its introduction more than 10 years ago, several ...modifications in grafting technique and postoperative treatment regimen helped to improve its safety and reproducibility. Although DMEK offers faster and better improvements in visual acuity, as well as less graft rejections when compared to Descemet's stripping (automated) endothelial keratoplasty (DSAEK), difficulties when implementing this technique hamper the widespread use in many areas. However, different strategies help to reduce the rate of intra- and postoperative complications, making DMEK the method of choice for most patients with corneal endothelial diseases. Certain techniques help to reduce the endothelial damage during graft preparation; correct matching of donor age and recipient's anterior chamber depth eases intracameral unfolding of the DMEK graft, the use of SF
gas for anterior chamber tamponade reduces the need for additional rebubblings, and the correct frequency and duration of postoperative topical steroid treatment helps to reduce the development of cystoid macular edema and graft rejections. Further standardization, but also individualization, of DMEK helps to offer this treatment option to patients with more complex anterior segment situations like anterior synechia, larger iris defects and glaucoma drainage devices.
To report an unusual case of subperiosteal bleeding of nontraumatic etiology.
A 48-year-old female presented with an acute protrusion of the left eye after nonaccomplished suicide by means of ...asphyxia using a cable around the neck. At the time of presentation, the MRI showed an orbital subperiosteal hematoma causing an exophthalmos. After conservative treatment, there was a complete remission of the lesion.
Nontraumatic subperiosteal bleedings without involvement of the intraocular structures and no vision-threatening intraorbital changes should be treated conservatively.
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