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Influence of Lens Status on Outcomes of Descemet Membrane Endothelial Keratoplasty

Godin, Morgan R., MD; Boehlke, Christopher S., MD; Kim, Terry, MD; Gupta, Preeya K., MD

doi: 10.1097/ICO.0000000000001872
Clinical Science

Purpose: To evaluate whether lens status influences clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in patients who underwent DMEK in phakia, pseudophakia, or combined with cataract surgery (triple).

Methods: A retrospective review of 139 eyes (107 patients) with symptomatic Fuchs' dystrophy or secondary corneal edema was performed. Patients were divided into 3 groups: 1) DMEK + cataract surgery, 2) DMEK in pseudophakia, and 3) DMEK in phakia.

Results: Of 139 DMEK surgeries, 61 were DMEK triple (43.9%), 55 pseudophakic DMEK (39.6%), and 23 phakic DMEK (16.5%) procedures. Rebubble occurred in 31 of 134 eyes (23.1%), of which 17 were in eyes after DMEK triple (28.3%), 10 after pseudophakic DMEK (19.6%), and 4 after phakic DMEK (17.4%). There was no statistically significant difference in rebubble rates depending on lens status (P = 0.548). There was no statistically significant difference in best corrected visual acuity (BCVA) between eyes that underwent rebubble versus not (P = 0.854). BCVA in patients post-DMEK was 20/25 or better in 81% of cases, and mean BCVA was 20/23. Donor age (P = 0.889), graft cell count (P = 0.525), and graft preparation technique (P = 0.769) were not predictive of rebubbling.

Conclusions: Our study demonstrates no difference in DMEK outcome with regard to rebubble rate whether the procedure is performed in combination with cataract surgery, in pseudophakia, or in phakia. Furthermore, donor age, initial graft cell count, and graft preparation technique did not impact rebubble rate. BCVA was also not affected by the need for rebubbling.

Division of Cornea and Refractive Surgery, Department of Ophthalmology, Duke University Eye Center, Durham, NC.

Correspondence: Preeya K. Gupta, MD, Division of Cornea and Refractive Surgery, Department of Ophthalmology, Duke University Eye Center, 4709 Creekstone Drive, Suite 100, Durham, NC 27703 (e-mail:

P. K. Gupta is a consultant to Aurea, Allergan, Alcon, Bio-Tissue, Johnson and Johnson Vision, Kala, NovaBay, Novartis, Ocular Science, Shire, TearLab, TearScience, and Zeiss. T. Kim is a consultant to Aerie Pharmaceuticals, Alcon, Allergan, Avedro, Avellino Labs, B&L, Blephex, CoDa/Ocunexus Therapeutics, Kala Pharmaceuticals, NovaBay Pharmaceuticals, Ocular Therapeutix, Omeros, PowerVision, Presbyopia Therapies, Shire, SightLife Surgical Inc, Silk Technologies, Simple Contacts, TearLab, and TearScience. The remaining authors have no funding or conflicts of interest to disclose.

Received August 31, 2018

Received in revised form December 04, 2018

Accepted December 06, 2018

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