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Learning Curve in Descemet's Membrane Endothelial Keratoplasty: First Series of 135 Consecutive Cases.

Abstract：

PURPOSE:To evaluate the learning curve in Descemet's membrane endothelial keratoplasty (DMEK) in the management of corneal endothelial disorders. DESIGN:Retrospective, nonrandomized, clinical study at a tertiary referral center. PARTICIPANTS:We included 135 eyes of 118 patients with Fuchs' endothelial dystrophy. METHODS:In a first group of 135 consecutive eyes, a DMEK was performed. To determine the extent of a possible learning curve in DMEK surgery, the whole group was divided into 3 subgroups of 45 patients, to compare clinical outcomes at 1, 3, and 6 months. MAIN OUTCOME MEASURES:Best-corrected visual acuity (BCVA), endothelial cell density (ECD), and intra- and postoperative complications. RESULTS:Among the 3 groups clinical outcomes were similar, with 73% of cases achieving a BCVA of ≥20/25 (≥0.8) and an average ECD of 1747 ± 527 cells/mm², at 6 months. Graft detachment was the main complication and correlated with intraoperative vitreous pressure (P<0.01). The detachment rate declined with experience: In the first 45 cases, a complete or partial graft detachment occurred in 20%, in the second group in 13.3%, and in the third group in 4.4%. Other complications were relatively uncommon: Failure to unfold or position the graft during surgery (0.7%), intraocular hemorrhage (0.7%), primary graft failure (2.2%), air-bubble induced angle closure glaucoma (3%), remnant host Descemet's at the interface (5.9%), and cystoid macular edema (0.7%). Surgeries (partially) performed by an inexperienced surgeon showed a similar clinical outcome and complication rate. CONCLUSIONS:The learning curve in DMEK did not correlate with clinical outcome (BCVA and ECD), but rather to the presence of a functional graft. However, the number of functional grafts (decline in graft detachment rate) increased with surgical experience. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosures may be found after the references.

journal_name

Ophthalmology

journal_title

Ophthalmology

authors

Dapena I,Ham L,Droutsas K,van Dijk K,Moutsouris K,Melles GR

doi

10.1016/j.ophtha.2011.03.037

subject

Has Abstract

pub_date

2011-11-01 00:00:00

pages

2147-54

issue

eissn

0161-6420

issn

1549-4713

pii

S0161-6420(11)00329-0

journal_volume

118

pub_type

临床试验,杂志文章

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Learning Curve in Descemet's Membrane Endothelial Keratoplasty: First Series of 135 Consecutive Cases.