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Descemet Membrane Endothelial Keratoplasty: Safety and Outcomes: A Report by the American Academy of Ophthalmology.

Publication ,  Journal Article
Deng, SX; Lee, WB; Hammersmith, KM; Kuo, AN; Li, JY; Shen, JF; Weikert, MP; Shtein, RM
Published in: Ophthalmology
February 2018

PURPOSE: To review the published literature on the safety and outcomes of Descemet membrane endothelial keratoplasty (DMEK) for the surgical treatment of corneal endothelial dysfunction. METHODS: Literature searches were last conducted in the PubMed and the Cochrane Library databases most recently in May 2017. The searches, which were limited to English-language abstracts, yielded 1085 articles. The panel reviewed the abstracts, and 47 were determined to be relevant to this assessment. RESULTS: After DMEK surgery, the mean best-corrected visual acuity (BCVA) ranged from 20/21 to 20/31, with follow-up ranging from 5.7 to 68 months. At 6 months, 37.6% to 85% of eyes achieved BCVA of 20/25 or better and 17% to 67% achieved BCVA of 20/20 or better. Mean endothelial cell (EC) loss was 33% (range, 25%-47%) at 6 months. Overall change in spherical equivalent was +0.43 diopters (D; range, -1.17 to +1.2 D), with minimal induced astigmatism of +0.03 D (range, -0.03 to +1.11 D). The most common complication was partial graft detachment requiring air injection (mean, 28.8%; range, 0.2%-76%). Intraocular pressure elevation was the second most common complication (range, 0%-22%) after DMEK, followed by primary graft failure (mean, 1.7%; range, 0%-12.5%), secondary graft failure (mean, 2.2%; range, 0%-6.3%), and immune rejection (mean, 1.9%; range, 0%-5.9%). Overall graft survival rates after DMEK ranged from 92% to 100% at last follow-up. Best-corrected visual acuity after Descemet's stripping endothelial keratoplasty (DSEK) ranged from 20/34 to 20/66 at 9 months. The most common complications after DSEK were graft detachment (mean, 14%; range, 0%-82%), endothelial rejection (mean, 10%; range, 0%-45%), and primary graft failure (mean, 5%; range, 0%-29%). Mean EC loss after DSEK was 37% at 6 months. CONCLUSIONS: The evidence reviewed supports DMEK as a safe and effective treatment for endothelial failure. With respect to visual recovery time, visual outcomes, and rejection rates, DMEK seems to be superior to DSEK and to induce less refractive error with similar surgical risks and EC loss compared with DSEK. The rate of air injection and repeat keratoplasty were similar in DMEK and DSEK after the learning curve for DMEK.

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Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

February 2018

Volume

125

Issue

2

Start / End Page

295 / 310

Location

United States

Related Subject Headings

  • United States
  • Ophthalmology & Optometry
  • Ophthalmology
  • Humans
  • Fuchs' Endothelial Dystrophy
  • Descemet Stripping Endothelial Keratoplasty
  • Academies and Institutes
  • 3212 Ophthalmology and optometry
  • 1117 Public Health and Health Services
  • 1113 Opthalmology and Optometry
 

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Deng, S. X., Lee, W. B., Hammersmith, K. M., Kuo, A. N., Li, J. Y., Shen, J. F., … Shtein, R. M. (2018). Descemet Membrane Endothelial Keratoplasty: Safety and Outcomes: A Report by the American Academy of Ophthalmology. Ophthalmology, 125(2), 295–310. https://doi.org/10.1016/j.ophtha.2017.08.015
Deng, Sophie X., W Barry Lee, Kristin M. Hammersmith, Anthony N. Kuo, Jennifer Y. Li, Joanne F. Shen, Mitchell P. Weikert, and Roni M. Shtein. “Descemet Membrane Endothelial Keratoplasty: Safety and Outcomes: A Report by the American Academy of Ophthalmology.Ophthalmology 125, no. 2 (February 2018): 295–310. https://doi.org/10.1016/j.ophtha.2017.08.015.
Deng SX, Lee WB, Hammersmith KM, Kuo AN, Li JY, Shen JF, et al. Descemet Membrane Endothelial Keratoplasty: Safety and Outcomes: A Report by the American Academy of Ophthalmology. Ophthalmology. 2018 Feb;125(2):295–310.
Deng, Sophie X., et al. “Descemet Membrane Endothelial Keratoplasty: Safety and Outcomes: A Report by the American Academy of Ophthalmology.Ophthalmology, vol. 125, no. 2, Feb. 2018, pp. 295–310. Pubmed, doi:10.1016/j.ophtha.2017.08.015.
Deng SX, Lee WB, Hammersmith KM, Kuo AN, Li JY, Shen JF, Weikert MP, Shtein RM. Descemet Membrane Endothelial Keratoplasty: Safety and Outcomes: A Report by the American Academy of Ophthalmology. Ophthalmology. 2018 Feb;125(2):295–310.
Journal cover image

Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

February 2018

Volume

125

Issue

2

Start / End Page

295 / 310

Location

United States

Related Subject Headings

  • United States
  • Ophthalmology & Optometry
  • Ophthalmology
  • Humans
  • Fuchs' Endothelial Dystrophy
  • Descemet Stripping Endothelial Keratoplasty
  • Academies and Institutes
  • 3212 Ophthalmology and optometry
  • 1117 Public Health and Health Services
  • 1113 Opthalmology and Optometry