Outcomes and safety of Descemet's membrane endothelial keratoplasty (DMEK) as a surgical treatment for corneal endothelial dysfunction: A multicenter study

Purpose. - To analyze the outcomes and frequency of complications after Descemet's membrane endothelial keratoplasty (DMEK) and evaluate the parameters associated with the occurrence of these complications. Methods. - A multicenter retrospective study of 143 DMEK procedures performed consecutively by five surgeons between June 2018 and March 2021 was performed. Surgeon-specific surgical and graft characteristics were also assessed. Data on best-corrected visual acuity (BCVA), central pachymetry, and endothelial cell density (ECD) were collected at one, three, six, and 12 months. Postoperative complications and secondary procedures (rebubbling and regrafting) were also recorded. Results. - The mean BCVA at one year was 0.17 logMAR (+/- 0.19). There was a mean hyperopic shift at one year of +0.26 diopters. The mean pachymetry at one year was 526 mu m (+/- 53). The mean ECD at one year was 1164cells/mm2 (+/- 479). Graft detachment occurred in 51% of the procedures and was significantly associated with the performance of an intraoperative iridotomy (OR = 2.8) [95% CI: 1.2-6.6]. Rebubbling occurred in 34% of the procedures, and a new graft was performed in 21% of cases. Conclusion. - Performing a peripheral iridotomy during DMEK is a significant risk factor for graft detachment. DMEK significantly improves patients' vision and restores normal pachymetry. (c) 2024 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).