Femto-DMEK – a solution for high re-bubbling rates?
Reviewed by Magdalena Popiela

This retrospective study examined results of patients that underwent femtosecond laser enabled descemet membrane endothelial keratoplasty (DMEK) (FE-DMEK) and manual DMEK (M-DMEK) for Fuch’s endothelial dystrophy. In FE-DMEK femtosecond laser was used to create 8.25mm descemetorhexis, whereas during M-DMEK- descemetorhexis was made with reverse Sinskey hook in the standard fashion. All patients underwent phacoemulsification at the same time as their DMEKS with 17 eyes having FE-DMEK and 89 eyes M-DMEK. Postoperative best corrective visual acuity (BCVA) at six months of follow-up was similar for both groups: 0.19 ± 0.13 logMAR (mean Snellen 20/30) in the FE-DMEK group and 0.35 ± 0.48 logMAR (mean Snellen 20/45) in the M-DMEK group (P=0.218). Improvements in BCVA and endothelial cell losses at six months for both groups were similar. In the FE-DMEK group, no issues with descemetorhexis creation were noted and no significant intraoperative complications occurred in either group. Most importantly, none of the eyes in the FE-DMEK group had significant graft detachment compared with 18 eyes (20%) in M-DMEK group, which required re-bubbling in 15 M-DMEK eyes (17%). This study describes another surgical application of femtosecond laser. Femtosecond laser reduced the rates of graft detachment and there was no need for rebubbling in described cohort of patients. Further studies and treated patients numbers are needed to establish if FE-DMEK could become a standard of care in DMEK surgery.

Comparison of femtosecond laser-enabled descemetorhexis and manual descemetorhexis in descemet membrane endothelial keratoplasty.
Einan-Lifshitz A, Sorkin N, Boutin T, et al.
CORNEA
2017;36(7):767-70.