Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand

Kaevalin Lekhanont,1 Punyanuch Pisitpayat,1 Nontawat Cheewaruangroj,1 Passara Jongkhajornpong,1 Manachai Nonpassopon,1 Thunyarat Anothaisintawee2 1Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Family Medicine, Faculty of...

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Autores principales:	Lekhanont K, Pisitpayat P, Cheewaruangroj N, Jongkhajornpong P, Nonpassopon M, Anothaisintawee T
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	descemet membrane endothelial keratoplasty endothelial keratoplasty asian outcomes risk factors complications Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/6102489552274b6fbeaa855179b22d74
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spelling	oai:doaj.org-article:6102489552274b6fbeaa855179b22d742021-12-02T14:39:27ZOutcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand1177-5483https://doaj.org/article/6102489552274b6fbeaa855179b22d742021-05-01T00:00:00Zhttps://www.dovepress.com/outcomes-of-descemet-membrane-endothelial-keratoplasty-in-bangkok-thai-peer-reviewed-fulltext-article-OPTHhttps://doaj.org/toc/1177-5483Kaevalin Lekhanont,1 Punyanuch Pisitpayat,1 Nontawat Cheewaruangroj,1 Passara Jongkhajornpong,1 Manachai Nonpassopon,1 Thunyarat Anothaisintawee2 1Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Kaevalin LekhanontDepartment of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Road, Rajathevi, Bangkok, 10400, ThailandTel +662-201-1560Fax +662-201-1516Email lekhanont@yahoo.comPurpose: To investigate the medium-term clinical outcomes and risk factors for primary graft failure after Descemet membrane endothelial keratoplasty (DMEK) in Thai patients.Patients and Methods: This is a single-center retrospective cohort study. Sixty-two eyes of 62 patients who underwent DMEK at Ramathibodi Hospital, Bangkok, Thailand, with a minimum of 24-month follow-up were recruited. Preoperative donor and recipient characteristics, intraoperative data, and postoperative outcomes including best-corrected visual acuity (BCVA), graft clarity, endothelial cell density (ECD), central corneal thickness (CCT), and complications were evaluated at 1, 3, 6, 12, and 24 months after surgery.Results: The mean age of the patients was 67.2 ± 9.9 years, and 52% were female. The mean follow-up time was 37.5 ± 11.0 months. The most common indications for DMEK were Fuchs’ endothelial corneal dystrophy (FECD) (53.2%) and pseudophakic bullous keratopathy (PBK) (17.7%). Nearly half of patients had triple-DMEK. The median preoperative BCVA was 20/400. Postoperative BCVA of ≥ 20/40 was reached in 37.1% and of ≥ 20/20 in 6.5% after 1 month which increased to 54.8% and 17.7% after 3 months; and to 67.7% and 27.4% after 24 months. Endothelial cell loss (ECL) at 3, 6, 12, and 24 months was 30.5%, 33.8%, 44.4%, and 45.9%, respectively. Graft diameter was the single factor, showing a significant relationship with postoperative ECD. Most frequent postoperative complications included graft detachment (22.6%), increased IOP/glaucoma (17.7%), and primary graft failure (16.1%). In univariate analysis, death-to-operation time and the diagnosis of PBK were significantly associated with the occurrence of primary graft failure.Conclusion: DMEK is a safe, effective, and feasible treatment for endothelial failure in Asian eyes. Careful case selection, use of relatively fresh donor tissues, and appropriate surgical techniques can prevent primary graft failure and facilitate optimal outcomes following surgery.Keywords: Descemet membrane endothelial keratoplasty, endothelial keratoplasty, Asian, outcomes, risk factors, complicationsLekhanont KPisitpayat PCheewaruangroj NJongkhajornpong PNonpassopon MAnothaisintawee TDove Medical Pressarticledescemet membrane endothelial keratoplastyendothelial keratoplastyasianoutcomesrisk factorscomplicationsOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 2239-2251 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	descemet membrane endothelial keratoplasty endothelial keratoplasty asian outcomes risk factors complications Ophthalmology RE1-994
spellingShingle	descemet membrane endothelial keratoplasty endothelial keratoplasty asian outcomes risk factors complications Ophthalmology RE1-994 Lekhanont K Pisitpayat P Cheewaruangroj N Jongkhajornpong P Nonpassopon M Anothaisintawee T Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand
description	Kaevalin Lekhanont,1 Punyanuch Pisitpayat,1 Nontawat Cheewaruangroj,1 Passara Jongkhajornpong,1 Manachai Nonpassopon,1 Thunyarat Anothaisintawee2 1Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Kaevalin LekhanontDepartment of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Road, Rajathevi, Bangkok, 10400, ThailandTel +662-201-1560Fax +662-201-1516Email lekhanont@yahoo.comPurpose: To investigate the medium-term clinical outcomes and risk factors for primary graft failure after Descemet membrane endothelial keratoplasty (DMEK) in Thai patients.Patients and Methods: This is a single-center retrospective cohort study. Sixty-two eyes of 62 patients who underwent DMEK at Ramathibodi Hospital, Bangkok, Thailand, with a minimum of 24-month follow-up were recruited. Preoperative donor and recipient characteristics, intraoperative data, and postoperative outcomes including best-corrected visual acuity (BCVA), graft clarity, endothelial cell density (ECD), central corneal thickness (CCT), and complications were evaluated at 1, 3, 6, 12, and 24 months after surgery.Results: The mean age of the patients was 67.2 ± 9.9 years, and 52% were female. The mean follow-up time was 37.5 ± 11.0 months. The most common indications for DMEK were Fuchs’ endothelial corneal dystrophy (FECD) (53.2%) and pseudophakic bullous keratopathy (PBK) (17.7%). Nearly half of patients had triple-DMEK. The median preoperative BCVA was 20/400. Postoperative BCVA of ≥ 20/40 was reached in 37.1% and of ≥ 20/20 in 6.5% after 1 month which increased to 54.8% and 17.7% after 3 months; and to 67.7% and 27.4% after 24 months. Endothelial cell loss (ECL) at 3, 6, 12, and 24 months was 30.5%, 33.8%, 44.4%, and 45.9%, respectively. Graft diameter was the single factor, showing a significant relationship with postoperative ECD. Most frequent postoperative complications included graft detachment (22.6%), increased IOP/glaucoma (17.7%), and primary graft failure (16.1%). In univariate analysis, death-to-operation time and the diagnosis of PBK were significantly associated with the occurrence of primary graft failure.Conclusion: DMEK is a safe, effective, and feasible treatment for endothelial failure in Asian eyes. Careful case selection, use of relatively fresh donor tissues, and appropriate surgical techniques can prevent primary graft failure and facilitate optimal outcomes following surgery.Keywords: Descemet membrane endothelial keratoplasty, endothelial keratoplasty, Asian, outcomes, risk factors, complications
format	article
author	Lekhanont K Pisitpayat P Cheewaruangroj N Jongkhajornpong P Nonpassopon M Anothaisintawee T
author_facet	Lekhanont K Pisitpayat P Cheewaruangroj N Jongkhajornpong P Nonpassopon M Anothaisintawee T
author_sort	Lekhanont K
title	Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand
title_short	Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand
title_full	Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand
title_fullStr	Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand
title_full_unstemmed	Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand
title_sort	outcomes of descemet membrane endothelial keratoplasty in bangkok, thailand
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/6102489552274b6fbeaa855179b22d74
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Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand

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