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Fellow Eye Comparison of Descemet Membrane Endothelial Keratoplasty and Penetrating Keratoplasty

Maier, Anna-Karina B. MD; Gundlach, Enken MD; Gonnermann, Johannes MD; Klamann, Matthias K.J. MD; Eulufi, Christian MD; Bertelmann, Eckart MD; Joussen, Antonia M. MD; Torun, Necip MD

doi: 10.1097/ICO.0b013e31829dd816
Clinical Science

Purpose: To compare the visual outcomes and postoperative complications in patients undergoing penetrating keratoplasty (PKP) in 1 eye followed by Descemet membrane endothelial keratoplasty (DMEK) in their fellow eye.

Methods: A retrospective analysis of 11 patients, who underwent a PKP procedure first in 1 eye and then a DMEK surgery in their fellow eye, was performed. Intraoperative and postoperative complications were recorded. Visual and refractive outcomes were also evaluated, including higher-order aberrations (HOAs) and contrast thresholds. A subjective questionnaire was used to evaluate patient satisfaction.

Results: Both uncorrected and best-corrected visual acuities were significantly better in the case of DMEK when compared with that in the case of PKP (0.82 vs. 0.37 logMAR, P = 0.005; 0.61 vs. 0.21 logMAR, P = 0.011, respectively). Postkeratoplasty astigmatism, mean spherical equivalent, and HOAs were also significantly lower in eyes after undergoing DMEK than after undergoing PKP (3.90 vs. 0.89 diopters, P = 0.005; −3.90 vs. −0.68 diopters, P = 0.005; 6.81 vs. 1.71 µm, P = 0.043, respectively). Visual outcome and patient satisfaction were significantly better in those who underwent DMEK (2.91 vs. 4.45, P = 0.011; 3.27 vs. 5.64, P = 0.016, respectively). The estimated time for recovery and rehabilitation was significantly shorter after DMEK (64.0 vs. 9.3 days, P = 0.012). Contrast threshold was better after the DMEK. Ten of 11 patients preferred DMEK procedure.

Conclusions: The Patients preferred DMEK to PKP. The reasons for better patient satisfaction after DMEK included better uncorrected visual acuity, better best-corrected visual acuity, avoidance of surgery-induced astigmatism, and lower HOA.

Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.

Reprints: Anna-Karina B. Maier, Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany (e-mail: anna-karina.maier@charite.de).

Supported by the Friedrich C. Luft Clinical Scientist Pilot Program funded by Volkswagen Foundation and Charité Foundation (A-K.B.M) and the Ernst und Bertha Grimmke Stiftung (E.G.).

The authors have no conflicts of interest to disclose.

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Received March 07, 2013

Accepted May 26, 2013

© 2013 by Lippincott Williams & Wilkins.