Descemet Membrane Endothelial Keratoplasty in Asian Eyes: Intraoperative and Postoperative Complications

Purpose: To describe intraoperative and postoperative complications of Descemet membrane endothelial keratoplasty (DMEK) in Asian eyes. Methods: A prospective comparative study of consecutive cases of DMEK cases between January 2016 and January 2018. A subgroup of consecutive patients were optimized with preoperative topical eye drops and modification of donor insertion. Main outcome measures were intraoperative complications and total surgical time. Secondary outcome measures were postoperative complications and endothelial cell loss (ECL) at the 6-month follow-up. Results: We included 50 consecutive patients in this study; mean age of 66 +/- 9 years old with 70% women. The indications for DMEK were Fuchs endothelial dystrophy (82%) and bullous keratopathy (18%). When compared with the standard group (n = 24 eyes), the optimized DMEK group (n = 26 eyes) was associated with a significantly reduced surgical time (33.9 +/- 12.7 vs. 26.9 +/- 7.6 minutes;P= 0.041), lower ECL at 6 months (27.2 +/- 17.1% vs. 13.7 +/- 9.7%;P= 0.012) and lower risk of high vitreous pressure causing iris prolapse (16.7% vs. 0%;P= 0.046). Multivariate analysis revealed a shorter surgical time (Odds Ratio [OR]: 0.924; 95% confidence interval: 0.858-0.995;P= 0.036) and reduced ECL (OR: 0.907; 95% confidence interval: 0.843-0.977;P= 0.01) in the optimized group. Conclusions: We observed intraoperative challenges such as difficulty with donor insertion with increased vitreous pressure in Asian eyes by performing DMEK surgery, which may be reduced with anticipated preoperative and postoperative measures.