Ophthalmology · 2011
Learning Curve in Descemet's Membrane Endothelial Keratoplasty: First Series of 135 Consecutive Cases.
Клиническое исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Dapena Isabel, Ham Lisanne, Droutsas Konstantinos, van Dijk Korine, Moutsouris Kyros, Melles Gerrit R J
Аннотация
PURPOSE: To evaluate the learning curve in Descemet's membrane endothelial keratoplasty (DMEK) in the management of corneal endothelial disorders.
DESIGN: Retrospective, nonrandomized, clinical study at a tertiary referral center.
PARTICIPANTS: We included 135 eyes of 118 patients with Fuchs' endothelial dystrophy.
METHODS: In a first group of 135 consecutive eyes, a DMEK was performed. To determine the extent of a possible learning curve in DMEK surgery, the whole group was divided into 3 subgroups of 45 patients, to compare clinical outcomes at 1, 3, and 6 months.
MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA), endothelial cell density (ECD), and intra- and postoperative complications.
RESULTS: Among the 3 groups clinical outcomes were similar, with 73% of cases achieving a BCVA of ≥20/25 (≥0.8) and an average ECD of 1747 ± 527 cells/mm², at 6 months. Graft detachment was the main complication and correlated with intraoperative vitreous pressure (P<0.01). The detachment rate declined with experience: In the first 45 cases, a complete or partial graft detachment occurred in 20%, in the second group in 13.3%, and in the third group in 4.4%. Other complications were relatively uncommon: Failure to unfold or position the graft during surgery (0.7%), intraocular hemorrhage (0.7%), primary graft failure (2.2%), air-bubble induced angle closure glaucoma (3%), remnant host Descemet's at the interface (5.9%), and cystoid macular edema (0.7%). Surgeries (partially) performed by an inexperienced surgeon showed a similar clinical outcome and complication rate.
CONCLUSIONS: The learning curve in DMEK did not correlate with clinical outcome (BCVA and ECD), but rather to the presence of a functional graft. However, the number of functional grafts (decline in graft detachment rate) increased with surgical experience.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosures may be found after the references.
DESIGN: Retrospective, nonrandomized, clinical study at a tertiary referral center.
PARTICIPANTS: We included 135 eyes of 118 patients with Fuchs' endothelial dystrophy.
METHODS: In a first group of 135 consecutive eyes, a DMEK was performed. To determine the extent of a possible learning curve in DMEK surgery, the whole group was divided into 3 subgroups of 45 patients, to compare clinical outcomes at 1, 3, and 6 months.
MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA), endothelial cell density (ECD), and intra- and postoperative complications.
RESULTS: Among the 3 groups clinical outcomes were similar, with 73% of cases achieving a BCVA of ≥20/25 (≥0.8) and an average ECD of 1747 ± 527 cells/mm², at 6 months. Graft detachment was the main complication and correlated with intraoperative vitreous pressure (P<0.01). The detachment rate declined with experience: In the first 45 cases, a complete or partial graft detachment occurred in 20%, in the second group in 13.3%, and in the third group in 4.4%. Other complications were relatively uncommon: Failure to unfold or position the graft during surgery (0.7%), intraocular hemorrhage (0.7%), primary graft failure (2.2%), air-bubble induced angle closure glaucoma (3%), remnant host Descemet's at the interface (5.9%), and cystoid macular edema (0.7%). Surgeries (partially) performed by an inexperienced surgeon showed a similar clinical outcome and complication rate.
CONCLUSIONS: The learning curve in DMEK did not correlate with clinical outcome (BCVA and ECD), but rather to the presence of a functional graft. However, the number of functional grafts (decline in graft detachment rate) increased with surgical experience.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosures may be found after the references.
Предметные рубрики MeSH
AdultAgedAged, 80 and overCell CountCell SurvivalClinical CompetenceDescemet Stripping Endothelial KeratoplastyEndothelium, CornealFemaleFuchs' Endothelial DystrophyHumansIntraoperative ComplicationsLearning CurveMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesTissue DonorsTomography, Optical CoherenceTreatment OutcomeVisual Acuity