This retrospective analysis of 11 patients who underwent penetrating keratoplasty (PKP) in their first eye followed by descemet membrane endothelial keratoplasty (DMEK) in their second eye studied visual and refractive outcomes. Intra and postoperative complications were compared and a subjective questionnaire to evaluate patient satisfaction is reported. In all cases the indication for surgery was Fuchs’ endothelial dystrophy. Visual acuity (VA) improved compared to preoperatively in both groups but in the DMEK group was significantly higher at the last follow-up. The mean manifest spherical equivalent and manifest cylinder were higher in those who underwent PKP than those who underwent DMEK. Eyes that underwent PKP demonstrated higher levels of higher order aberrations than DMEK patients. In terms of complications five cases of DMEK required additional intracameral air injection. In one case of DMEK there was raised intraocular pressure (IOP) one day post op. In two eyes with PKP resuturing was required and in one case a suture was placed for high astigmatism. In the questionnaire survey nine out of 11 patients evaluated their visual outcome post-surgery as being superior in the DMEK eye than the PKP eye. Visual outcomes were graded significantly higher. Four patients stated DMEK was more painful than PKP. There was no statistical difference in pain scores between the two procedures. Two patients complained of no significant improvement in VA after undergoing PKP. Mean patient satisfaction was significantly higher in the DMEK eyes as the mean recovery period was significantly greater in the PKP group. Ten out of 11 patients preferred DMEK, citing the use of general anaesthesia versus local anaesthesia as the deciding factor. The sample size is small in this study and there may be a recall bias in the patient questionnaire as the follow-up times for the two procedures are so different. However, the trend towards posterior lamellar surgery for Fuchs’ endothelial dystrophy is already set and more is being reported about the advantages. DMEK is a more challenging procedure than Descemet’s stripping automated endothelial keratoplasty (DSAEK) and most corneal graft surgeons in the UK are still doing DSAEK as the results of this are superior to PKP. 

Fellow eye comparison of descemet membrane endothelial keratoplasty (DMEK) and penetrating keratoplasty (PKP).
Maier A-K B, Gundlach E, Gonnermann J, et al.
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Sharmina Khan

Moorfields Eye Hospital, London, UK

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