Z HOT TOPIC Z 

Authors: Nir Sorkin, Zale Mednick, Adi Einan-Lifshitz, Tanya Trinh, Gisella Santaella, Alexandre Telli, Clara C. Chan, David S. Rootman
Author Disclosure Block: N. Sorkin: None. Z. Mednick: None. A. Einan-Lifshitz: None. T. Trinh: None. G. Santaella: None. A. Telli: None. C.C. Chan: Any direct financial payments including receipt of honoraria; Allergan, Alcon Labs Inc., Shire, Santen. Membership on advisory boards or speakers’ bureaus; Allergan, Bausch & Lomb, Johnson & Johnson, Shire, Santen. Funded grants or clinical trials; Allergan, Bausch & Lomb, TearLab. D.S. Rootman: None.

Abstract Body:

Purpose: To evaluate long-term outcomes of femtosecond-enabled Descemet membrane endothelial keratoplasty (F-DMEK) compared with manual Descemet membrane endothelial keratoplasty (M-DMEK) in patients with Fuchs endothelial dystrophy (FED)
Study Design: A retrospective, interventional case series
Methods: Included were eyes with FED and cataract that underwent either F-DMEK or M-DMEK combined with cataract extraction at the Toronto Western Hospital, and had at least 18 months’ follow-up. Exclusion criteria: complicated anterior segments, previous vitrectomy, previous keratoplasty, corneal opacity or any other visually significant ocular comorbidity.
Results: Included were 16 eyes of 15 patients in the F-DMEK group (average follow-up 33.0±9.0 months) and 45 eyes of 40 patients in the M-DMEK group (average follow-up 32.0±7.0 months). There were no issues with the creation of femtosecond descemetorhexis (in the F-DMEK group) - all descemetorhexis cuts were complete. BSCVA improvement did not differ significantly between the groups at 1, 2 and 3 years (p=0.849, p=0.465 and p=0.936, respectively). Rates of significant detachment in F-DMEK and M-DMEK were 1 of 16 eyes (6.25%) and 16 of 45 eyes (35.6%), respectively (p=0.027). Rebubbling rates were 1 of 16 eyes (6.25%) and 15 of 45 eyes (33.3%), respectively (p=0.047). Cell-loss rates following F-DMEK and M-DMEK were 26.8% and 36.5% at 1 year (p=0.042), 30.5% and 42.3% at 2 years (p=0.008), 37% and 47.5% at 3 years (p=0.057), respectively. Graft failure rate was 0% in F-DMEK and 8.9% in M-DMEK (all were primary failures, p=0.565).
Conclusions: F-DMEK showed good long-term efficacy with reduced detachment, rebubble and cell-loss rates, compared with M-DMEK.