Rapid sequential DMEK safely delivers quick visual recovery

This retrospective review found no increased risk of complications in performing Descemet membrane endothelial keratoplasty (DMEK) in fellow eyes one to two weeks after first-eye DMEK surgery.

The authors believe this to be the first reported series of rapid sequential endothelial keratoplasty with or without cataract extraction.

The study included 12 patients with Fuchs’ dystrophy who underwent DMEK in both eyes within two weeks. Seven patients had bilateral DMEK one week apart and five patients underwent the procedure two weeks apart. Twelve eyes had triple procedures (cataract extraction, intraocular lens implantation, DMEK), seven eyes were pseudophakic before DMEK, and five eyes had clear lenses and remained phakic after DMEK.

Preoperatively, the median corrected distance visual acuity (CDVA) was 20/40 (range 20/15 to 20/70). By one month postoperatively, the median CDVA had improved to 20/25 (range 20/15 to 20/70). In the 10 patients examined between three and six months postoperatively, the median CDVA was 20/20 (range 20/15 to 20/30).

All grafts successfully attached and cleared. Four patients had bilateral air reinjection and one patient had unilateral air reinjection to treat partial graft detachment. The rate of air reinjection was comparable between single and triple procedures (P = 0.65). No other complications were noted.

The rapid first-eye visual recovery (median UDVA at one week = 20/60) allowed patients to maintain visual function when they had surgery in the second eye.

The authors conclude that DMEK brings corneal transplantation closer to cataract surgery in the speed of visual recovery and the time to full resumption of daily activities.