This was a prospective, interventional case series of 10 eyes from 10 patients who underwent hemi-descemet membrane endothelial keratoplasty (hemi-DMEK) for Fuchs endothelial dystrophy. The surgical technique for hemi DMEK procedure was similar to the circular DMEK except that a semicircular graft was obtained from half of the corneo-scleral button. Main outcome measures were best corrected visual acuity, endothelial cell density, central corneal thickness and postoperative complications. Follow-up appointments were for one day, one week, one, three, six, nine and 12 months and every six months thereafter. One eye received secondary circular DMEK one month postoperatively for persistent graft detachment after unsuccessful rebubbling, hence clinical outcomes of nine eyes with successful hemi DMEK surgery were reported. All corneas with successful hemi DMEK cleared by six months and best corrected visual acuity (BCVA) improved in all eyes. At one year postoperatively, all eyes attained BCVA of >=20/40, 86% >=20/25 and 57% >= 20/20. BCVA remained stable until two years postoperatively and further improved thereafter. Donor endothelial cell density decreased within the first postoperative year from 2740 (+/-180) cells/mm2 before surgery to 940 (+/- 380) cells/mm2 at six months and 850 (+/- 300) cells/mm2 at one year after surgery and showed an annual decrease of 6% to 7% thereafter, with a yearly decrease comparable to conventional DMEK. Mean pachymetry decreased from preoperatively 745(±153)µm to 533(±63)µm (n=9) and 527(±35)µm (n=8) at one and three years postoperatively, respectively. The main early complication was graft detachment, for which rebubbling was required in 4/10 (40%) eyes. The difference in graft shape and learning curve effect were considered as the reasons for this. One eye had mild allograft rejection. The authors concluded that although the case series was limited in size, the outcomes may be encouraging as this procedure may potentially increase the yield of endothelial tissue from the same donor pool while giving outcomes similar to conventional DMEK. Limitations: small series.
Outcomes of hemi DMEK
Reviewed by Bushra Thajudeen
Outcomes of hemi-descemet membrane endothelial keratoplasty for Fuchs endothelial corneal dystrophy.
