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  5. FP145 : Outcomes of First Consecutive 75 Eyes of DSEK Vs First 75 Eyes of...

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Dr. Soham Basak, B16308, Dr. Samar Kumar Basak

Descemet membrane endothelial keratoplasty (DMEK) is gradually gaining its popularity as the surgery of choice in endothelial dysfunction. In DMEK, the visual outcome is better and faster than DSEK with slightly higher endothelial cell loss.

The purpose of this study was tocompare the results of the first 75 DSEK and the first 75 DMEK by standard techniques by same surgeon during learning curve 10 years apart in the same hospital set up.

Methods: Retrospective comparative case series. The first 75 cases of DSEK during the year 2006-2007; and DMEK during the year 2016-2017 performed by a single surgeon were included and grouped. Indications, best-corrected visual acuity (BCVA), complications and endothelial cell loss (ECL) were compared in the two groups for up to 3 months follow-up.

Results: The commonest indication was pseudophakic corneal edema in both followed by Fuchs’ endothelial dystrophy. However the distribution was a different with more number of Fuchs’ patients in the DMEK group (38% vs 22.7% in DSEK); and therefore lesser number of post-cataract corneal decompensation patients (52% vs 70.7% in DSEK).

The criteria for donor endothelial cell density (ECD) was set higher in DMEK in anticipation of increased surgical manipulation (>2200 cells/mm2 in DSEK vs >2500 cells/mm2 in DMEK). Four tissues were damaged during DM-roll preparation in DMEK but there was no tissue damage in the DSEK surgeries. In both cases donor preparation was done manually by the surgeon himself. Another difference was whereas in the DSEK cases, all tissues were McCarey-Kaufman medium (MKM) stored, in the DMEK eyes both MKM and Cornisol stored tissues were used.

The DMEK patients especially Fuchs’ dystrophy patients were intervened at an earlier stage than in the DSEK groups – this is due to faster and better visual rehabilitation. (42% patients had 20/200 or better vision pre-op in DMEK patients but all patients in DSEK group were worse than 20/200).

After 3 months, 25.3% eyes in DSEK and 70.7% eyes in DMEK achieved BCVA ≥20/40 (P<0.01). ECL was 26.8±4.24% (range: 13.3-38.4%) after DSEK and 30.6±13.1% (range:4.9%-66.6%) after DMEK (P = 0.13). Though not statistically significant, ECL was higher in the DMEK group because DM-unrolling causes more surgical manipulation. Donor dislocation was more in DSEK eyes (8 vs. 1) and partial detachment more in DMEK (7 vs. 0) most of which resolved on its own with time. 8 eyes in DSEK required rebubbling and 3 in DMEK eyes. There was one primary graft failure in both groups.

Conclusions: Compared with DSEK, DMEK provided faster and better visual recovery with comparable ECL after 3 months. DSEK had a higher dislocation and DMEK eyes had higher partial detachment rate.

References:

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