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Descemet Membrane Endothelial Keratoplasty Using a Pull-Through Technique With Novel Infusion Forceps
Samir Jabbour1, Albert S Jun, Nakul S Shekhawat
1The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
Cornea
|December 8, 2020
Summary
Descemet membrane endothelial keratoplasty (DMEK) using a new technique with infusion forceps improved vision and reduced corneal thickness in Fuchs endothelial corneal dystrophy patients. This safe and effective method is suitable for surgeons at all experience levels.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Endothelial Keratoplasty
Background:
- Fuchs endothelial corneal dystrophy is a progressive condition affecting corneal clarity.
- Descemet membrane endothelial keratoplasty (DMEK) is a surgical option for restoring endothelial function.
- Standard DMEK techniques can have a learning curve for surgeons.
Purpose of the Study:
- To describe a novel Descemet membrane endothelial keratoplasty (DMEK) surgical technique using an endothelium-in pull-through approach with specialized infusion forceps.
- To evaluate the 6-month clinical outcomes of this DMEK technique in patients with Fuchs endothelial corneal dystrophy.
Main Methods:
- A retrospective case series of 33 patients with Fuchs endothelial corneal dystrophy undergoing DMEK.
- Procedures included DMEK alone, DMEK with phacoemulsification, or DMEK with intraocular lens exchange.
- Surgical outcomes assessed included visual acuity, refraction, corneal thickness, endothelial cell density, and complications over 6 months.
Main Results:
- Best-corrected visual acuity (BCVA) significantly improved from 0.37 to 0.09 logMAR (P < 0.001).
- 82% of eyes achieved a BCVA of 20/25 or better.
- Central corneal thickness decreased significantly, and endothelial cell loss was 29.1% at 6 months. Six eyes required rebubbling for graft detachments; no primary or secondary graft failures occurred.
Conclusions:
- Descemet membrane endothelial keratoplasty (DMEK) utilizing infusion microforceps is an effective and safe surgical approach for Fuchs endothelial corneal dystrophy.
- The technique offers enhanced control, making it suitable for both novice and experienced Descemet membrane endothelial keratoplasty (DMEK) surgeons.
