Descemet Membrane Endothelial Keratoplasty (DMEK) Anesthesia Analysis

Area of Science:

• Ophthalmology
• Surgical Innovation
• Anesthesia in Ophthalmic Surgery

Background:

• Descemet membrane endothelial keratoplasty (DMEK) is a leading surgical treatment for corneal endothelial dysfunction.
• Anesthesia choice in DMEK can impact surgical outcomes and patient experience.
• Understanding the safety and efficacy of different anesthesia techniques is crucial for optimizing DMEK procedures.

Purpose of the Study:

• To compare the safety and clinical results of DMEK performed under topical, peribulbar, or general anesthesia.
• To evaluate intraoperative complications, graft success rates, and visual outcomes across different anesthesia groups.

Main Methods:

• A retrospective, post hoc matched study involving 346 patients undergoing DMEK.
• Patients were categorized into three anesthesia groups: topical (n=54), peribulbar (n=137), and general (n=155).
• Key outcome measures included intraoperative complications, endothelial cell count (ECC), central corneal thickness (CCT), graft rejection rate, rebubbling rate, and visual acuity (VA), with a mean follow-up of 9.4 months.

Main Results:

• Topical anesthesia was associated with increased intraoperative difficulties, including vitreous pressure and challenges with graft unfolding, potentially leading to higher rebubbling rates.
• Rebubbling and graft failure rates were also influenced by graft preparation difficulty, independent of anesthesia type.
• Despite initial challenges, all anesthesia groups achieved comparable functional results in terms of VA, ECC, and CCT at 6 months post-surgery.

Conclusions:

• DMEK under topical anesthesia is a viable option with comparable long-term visual outcomes.
• Topical anesthesia for DMEK should be reserved for cooperative patients and performed by experienced surgeons due to potential intraoperative complexities.
• Careful patient selection and surgeon expertise are key to mitigating risks associated with topical anesthesia in DMEK.