Prospective Study of Visual Outcomes and Endothelial Survival With Descemet Membrane Automated Endothelial Keratoplasty

PURPOSE:To evaluate vision and endothelial cell survival in an initial Descemet membrane automated endothelial keratoplasty (DMAEK) series. METHODS:This was a prospective nonrandomized study of an initial consecutive series of 40 DMAEK cases, performed with or without concomitant phacoemulsification and intraocular lens implantation. The graft was dissected with a microkeratome. A central 6- to 7-mm big bubble was created to separate endothelium from stroma, and the overlying stroma was excised. The graft was cut to 8.5- to 9.5-mm diameter and inserted with a pull through technique. Eyes were treated for Fuchs endothelial dystrophy, secondary corneal decompensation, or previous failed endothelial transplant. Best spectacle-corrected visual acuity, manifest refraction, pachymetry, and endothelial cell density were assessed. RESULTS:Median best spectacle-corrected visual acuity was 20/30 at 1 month (range20/15-20/50), improved from 20/40 (range20/25-20/400) preoperatively, excluding 7 eyes (18%) with significant retinal pathology. Rates of 20/20, 20/25, 20/30, and 20/40 vision were 25%, 71%, 89%, and 100%, respectively, at 3 months and 48%, 74%, 93%, and 100%, respectively, at 6 months. Median endothelial cell loss relative to baseline donor cell density was 31% at 6 months. Air was reinjected in 10 eyes (25%) to promote graft attachment, and 2 grafts (5%) failed to clear. CONCLUSIONS:DMAEK provided significant improvement in visual acuity and marked reduction in central corneal thickness. DMAEK had a higher rate of postoperative air reinjection than Descemet stripping endothelial keratoplasty and comparable 6-month endothelial cell loss.