Clinical Outcomes of Descemet Membrane Endothelial Keratoplasty During the Surgeon Learning Curve Versus Descemet Stripping Endothelial Keratoplasty Performed at the Same Time

PURPOSE To compare outcomes after Descemet Membrane Endothelial Keratoplasty (DMEK) and traditional Descemet Stripping Endothelial Keratoplasty (DSEK) during the surgeon's DMEK learning curve in a prospective, non-randomized, consecutive, interventional case series. METHODS Consecutive patients presenting to the university eye clinics and undergoing endothelial keratoplasty were included. Data including patient demographics, visual acuity, endothelial cell counts and complications were recorded at baseline, as well as 3 and 6 months post-operatively. The primary outcome for this study was BSCVA at 6 months. Pre-specified secondary outcomes included endothelial cell counts and complication rates. RESULTS A total of 60 eyes of 42 consecutive patients met inclusion criteria, underwent endothelial keratoplasty, and were included in this analysis. Of these, 18 eyes of 14 patients had DSEK while 42 eyes of 28 patients had DMEK. After controlling for baseline visual acuity, study participants undergoing DMEK had a statistically significant approximately half-line improvement in visual acuity compared with DSEK at 3 months (P=0.05) but not at 6 months (P=0.22). DMEK patients experienced an average of 43% endothelial cell loss compared with 25% in DSEK. There were 5 primary graft failures after DMEK compared with 0 after DSEK and but this was not a statistically significant difference (P=0.09). CONCLUSION During the surgeon's DMEK learning curve there was some evidence of improved visual acuity outcomes in DMEK. We observed worse 6-month endothelial cell loss among DMEK patients; however this may improve with surgeon experience.