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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.

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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:

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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Received March 07, 2013

Accepted May 26, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.