Efficacy of descemet membrane endothelial keratoplasty: clinical outcome of 200 consecutive cases after a learning curve of 25 cases.

OBJECTIVE: To evaluate Descemet membrane endothelial keratoplasty for management of corneal endothelial disorders. METHODS: Descemet membrane endothelial keratoplasty was performed in 200 patients with Fuchs endothelial dystrophy or bullous keratopathy. Best-corrected visual acuity, subjective and objective refractive outcome and stability, and endothelial cell density were evaluated at 1, 3, and 6 months postoperatively, and intraoperative and postoperative complications were documented. RESULTS: At 6 months, 94% reached a best-corrected visual acuity of 20/40 or better (≥0.5); 77%, 20/25 or better (≥0.8); 47%, 20/20 or better (≥1.0), and 16%, 20/17 or better (≥1.2) (n = 159). The preoperative to 6 months' postoperative spherical equivalent showed a mean (SD) +0.38 (1.2) diopter hyperopic shift (P = .001) that correlated with a decrease in central corneal thickness (n = 143) (P = .047). Two-thirds of eyes showed refractive stability at 3 months. Donor endothelial cell density showed a decrease from mean (SD) 2560 (186) cells/mm(2) preoperatively to 1690 (520) cells/mm(2) at 6 months after surgery (n = 173) (P < .001). Graft detachment was the main complication and occurred in 18 eyes (9%). Recipient Descemet membrane remnants were present in 12 eyes (6%). Secondary glaucoma was seen in 8 eyes (4%), of which 4 showed air-bubble dislocation behind the iris. In 2 of 33 phakic eyes (6%), a secondary cataract developed requiring phacoemulsification. CONCLUSIONS: Descemet membrane endothelial keratoplasty may offer complete visual rehabilitation within 1 to 6 months after surgery in a majority of eyes. Similar to earlier keratoplasty techniques, Descemet membrane endothelial keratoplasty may be associated with a one-third decrease in donor endothelial cell density in the early postoperative phase. Incidence of (partial) graft detachment stabilized at about 5% but could be further reduced by patient selection and/or technique modification. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00521898.