Dr.Arun Kumar Panigrahi, Dr.Mano Ranjan Das
Transformation from DSAEK to DMEK – a journey worthwhile:
Introduction:
Keratoplasty has come a long way from penetrating keratoplasty to DSAEK to DMEK.DMEK is very popular among the corneal surgeons but still has not gained wider acceptance compared to DSAEK in view of relatively new and challenging technique .
Purpose:
To analyse outcome of first twenty five cases of DMEK performed by a single surgeon.
Materials and Methods:
A retrospective analysis of outcome of first 25 DMEK cases done by a single surgeon with 6 months followup Patient follow up data on 1st month 3rd month and 6th month was analysed. B.S.C.V.A,IOP by NCT, specular microscopy and ASOCT was done in all cases.
Results:
BSCVA of 6/9 or better was observed in 13 cases(>50%),and 6/12 or better was observed in 18 cases (72%).5 cases BSCVA of 6/60 or less out of which 2 case had CME with macular changes, 1 case had severe NPDR with CSME,2 cases had subepithelial scarring and persistent stromal edema . Specular was tried in all but obtained only in 15 cases,it showed CD loss of about 30 to 35 % at the end of 6 months.
Complications:
5 cases had slightly decentered DMEK lenticule without having any significant effect on visual outcome.3 cases had single peripheral fold in lenticule.6 cases had peripheral corneal edema which resolved gradually within 3 months.2 cases developed subepithelial scarring and had persistent stromal edema.Edema resolved gradually but subepithelilal scarring persisted resulting in BSCVA<6/60..1case showed AC reaction during 3rd month which reversed with tapering up of steroids for 2 weeks. Only one tissue was lost due to tear during DMEK tissue preparation
Discussion:
DMEK results in faster and better visual recovery. It also has an advantage over DSAEK as it does not require microkeratome for tissue preparation.Relatively lesser complications in first 25 cases shows that a welltrained surgeon with good wetlab training can reduce the learning curve to a great extent.
Conclusion:
Better and speedier visual recovery with reduced rejection rate indicate that DMEK is a wonderful surgery .A welltrained surgeon with adequate wetlab training will reduce the learning curve and make this journey really exciting.
Take home message:
More DSEK surgeons should convert to DMEK with proper training.
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