Top

Graefe's Archive for Clinical and Experimental Ophthalmology

Published in:

01-02-2019 | Cornea

Impact of preoperative visual acuity on Descemet Membrane Endothelial Keratoplasty (DMEK) outcome

Authors: Silvia Schrittenlocher, B. Bachmann, A. M. Tiurbe, O. Tuac, K. Velten, D. Schmidt, C. Cursiefen

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 2/2019

Abstract

Purpose

To evaluate whether and how preoperative visual acuity predicts visual acuity outcome after Descemet Membrane Endothelial Keratoplasty (DMEK).

Methods

One thousand eighty-four out of 1162 consecutive eyes having undergone DMEK alone or combined with cataract surgery (triple-DMEK) between July 2011 and February 2016 from the prospective Cologne DMEK database were included and analyzed retrospectively for correlations between pre- and postoperative visual acuity values at 1, 3, 6, and 12 months after transplantation.

Results

There is a significant correlation between pre- and postoperative visual acuity (VA) after (triple)-DMEK after 6 and 12 months (p = 0.005 and p = 0.011 respectively; Pearson’s correlation coefficient 0.240 and 0.224). Preoperative VA below 20/100 leads to delayed and reduced final visual acuity results after 12 months (p < 0.001). However, defining an increase in VA > 0.1 logMAR as clinically relevant, we could not show any clinically relevant significant difference in the time needed to recover to final VA and in final VA. There is no significant difference for preoperative VA values above 20/40. The chance to reach postoperative VA above 20/25 is 40% for preoperative VA of 20/200, 50% for preoperative VA of 20/60 and > 60% for preoperative VA of 20/40.

Conclusion

DMEK results in very good final postoperative visual acuity results even in eyes with very poor preoperative vision caused by corneal pathology. However, preoperative visual acuity values below 20/100 result in significantly poorer visual recovery, which suggests that there is benefit in performing surgery early enough before this value is reached. Preoperative visual acuity seems to be an adjuvant tool for the prediction of the final visual outcome after DMEK.

Available only for authorised users

Melles GR, Ong TS, Ververs B, van der Wees J (2006) Descemet membrane endothelial keratoplasty (DMEK). Cornea 25:987–990. https://doi.org/10.1097/01.ico.0000248385.16896.34 CrossRefPubMed

Price MO, Price FW (2007) Descemet’s stripping endothelial keratoplasty. Curr Opin Ophthalmol 18:290–294. https://doi.org/10.1097/ICU.0b013e3281a4775b CrossRefPubMed

Maier P, Reinhard T, Cursiefen C (2013) Descemet stripping endothelial keratoplasty--rapid recovery of visual acuity. Dtsch Arztebl Int 110:365–371. https://doi.org/10.3238/arztebl.2013.0365 CrossRefPubMedPubMedCentral

Steven P, Hos D, Heindl LM, Bock F, Cursiefen C (2013) Immune reactions after DMEK, DSAEK and DALK. Klin Monatsbl Augenheilkd 230:494–499. https://doi.org/10.1055/s-0032-1328257 CrossRefPubMed

Anshu A, Price MO, Price FW Jr (2012) Risk of corneal transplant rejection significantly reduced with Descemet’s membrane endothelial keratoplasty. Ophthalmology 119:536–540. https://doi.org/10.1016/j.ophtha.2011.09.019 CrossRefPubMed

Dapena I, Ham L, Netukova M, van der Wees J, Melles GR (2011) Incidence of early allograft rejection after Descemet membrane endothelial keratoplasty. Cornea 30:1341–1345. https://doi.org/10.1097/ICO.0b013e31820d8540 CrossRefPubMed

Hamzaoglu EC, Straiko MD, Mayko ZM, Sales CS, Terry MA (2015) The first 100 eyes of standardized Descemet stripping automated endothelial Keratoplasty versus standardized Descemet Membrane Endothelial Keratoplasty. Ophthalmology 122:2193–2199. https://doi.org/10.1016/j.ophtha.2015.07.003 CrossRefPubMed

Hos D, Tuac O, Schaub F, Stanzel TP, Schrittenlocher S, Hellmich M, Bachmann BO, Cursiefen C (2017) Incidence and clinical course of immune reactions after Descemet Membrane Endothelial Keratoplasty: retrospective analysis of 1000 consecutive eyes. Ophthalmology 124:512–518. https://doi.org/10.1016/j.ophtha.2016.12.017 CrossRefPubMed

Wilson SE, Bourne WM (1988) Fuchs’ dystrophy. Cornea 7:2–18CrossRefPubMed

10.

Amin SR, Baratz KH, McLaren JW, Patel SV (2014) Corneal abnormalities early in the course of Fuchs’ endothelial dystrophy. Ophthalmology 121:2325–2333. https://doi.org/10.1016/j.ophtha.2014.07.001 CrossRefPubMedPubMedCentral

11.

Baratz KH, McLaren JW, Maguire LJ, Patel SV (2012) Corneal haze determined by confocal microscopy 2 years after Descemet stripping with endothelial keratoplasty for Fuchs corneal dystrophy. Arch Ophthalmol 130:868–874. https://doi.org/10.1001/archophthalmol.2012.73 CrossRefPubMed

12.

Stanzel TP, Ersoy L, Sansanayudh W, Felsch M, Dietlein T, Bachmann B, Cursiefen C (2016) Immediate postoperative intraocular pressure changes after anterior chamber air fill in Descemet Membrane Endothelial Keratoplasty. Cornea 35:14–19. https://doi.org/10.1097/ICO.0000000000000669 CrossRefPubMed

13.

Kruse FE, Laaser K, Cursiefen C, Heindl LM, Schlotzer-Schrehardt U, Riss S, Bachmann BO (2011) A stepwise approach to donor preparation and insertion increases safety and outcome of Descemet membrane endothelial keratoplasty. Cornea 30:580–587CrossRefPubMed

14.

Hoerster R, Stanzel TP, Bachmann BO, Siebelmann S, Felsch M, Cursiefen C (2016) Intensified topical steroids as prophylaxis for macular edema after posterior lamellar keratoplasty combined with cataract surgery. Am J Ophthalmol 163:174–179 e172. https://doi.org/10.1016/j.ajo.2015.12.008 CrossRefPubMed

15.

Siebelmann S, Gehlsen U, Le Blanc C, Stanzel TP, Cursiefen C, Steven P (2016) Detection of graft detachments immediately following Descemet membrane endothelial keratoplasty (DMEK) comparing time domain and spectral domain OCT. Graefes Arch Clin Exp Ophthalmol. https://doi.org/10.1007/s00417-016-3484-x

16.

Jonah Gabry BG (2016) rstanarm: Bayesian applied regression modeling via Stan. R package version 2.13.1. Stan Development Team. http://mc-stan.org/. Accessed 27 Aug 2018

17.

Juho Piironen AV (2017) Comparison of Bayesian predictive methods for model selection. Stat Comput. https://doi.org/10.1007/s11222-016-9649-y

18.

Markus Paasiniemi JP, Vehtari A, Gabry J (2018) Projection Predictive Feature Selection https://CRAN.R-project.org/package=projpred Accessed 27 Aug 2018

19.

John Fox SW (2011) An {R} companion to applied regression. Sage, Thousand oaks CA

20.

Fox JaM G (1992) Generalized collinearity diagnostics. JASA 87:178–183CrossRef

21.

McLaren JW, Wacker K, Kane KM, Patel SV (2016) Measuring corneal haze by using Scheimpflug photography and confocal microscopy. Invest Ophthalmol Vis Sci 57:227–235. https://doi.org/10.1167/iovs.15-17657 CrossRefPubMedPubMedCentral

22.

Wacker K, McLaren JW, Amin SR, Baratz KH, Patel SV (2015) Corneal high-order aberrations and backscatter in Fuchs’ endothelial corneal dystrophy. Ophthalmology 122:1645–1652. https://doi.org/10.1016/j.ophtha.2015.05.005 CrossRefPubMedPubMedCentral

23.

Ripandelli G, Scarinci F, Piaggi P, Guidi G, Pileri M, Cupo G, Sartini MS, Parisi V, Baldanzellu S, Giusti C, Nardi M, Stirpe M, Lazzeri S (2015) Macular pucker: to peel or not to peel the internal limiting membrane? A microperimetric response. Retina 35:498–507. https://doi.org/10.1097/IAE.0000000000000330 CrossRefPubMed

24.

Grewing R, Mester U (1996) Results of surgery for epiretinal membranes and their recurrences. Br J Ophthalmol 80:323–326CrossRefPubMedPubMedCentral

25.

Asaria R, Garnham L, Gregor ZJ, Sloper JJ (2008) A prospective study of binocular visual function before and after successful surgery to remove a unilateral epiretinal membrane. Ophthalmology 115:1930–1937. https://doi.org/10.1016/j.ophtha.2008.05.020 CrossRefPubMed

26.

Falkner-Radler CI, Glittenberg C, Hagen S, Benesch T, Binder S (2010) Spectral-domain optical coherence tomography for monitoring epiretinal membrane surgery. Ophthalmology 117:798–805. https://doi.org/10.1016/j.ophtha.2009.08.034 CrossRefPubMed

27.

Scheerlinck LM, van der Valk R, van Leeuwen R (2015) Predictive factors for postoperative visual acuity in idiopathic epiretinal membrane: a systematic review. Acta Ophthalmol 93:203–212. https://doi.org/10.1111/aos.12537 CrossRefPubMed

28.

Kunikata H, Abe T, Kinukawa J, Nishida K (2011) Preoperative factors predictive of postoperative decimal visual acuity >/= 1.0 following surgical treatment for idiopathic epiretinal membrane. Clin Ophthalmol 5:147–154. https://doi.org/10.2147/OPTH.S15848 CrossRefPubMedPubMedCentral

29.

Inoue M, Morita S, Watanabe Y, Kaneko T, Yamane S, Kobayashi S, Arakawa A, Kadonosono K (2011) Preoperative inner segment/outer segment junction in spectral-domain optical coherence tomography as a prognostic factor in epiretinal membrane surgery. Retina 31:1366–1372. https://doi.org/10.1097/IAE.0b013e318203c156 CrossRefPubMed

30.

Rice TA, De Bustros S, Michels RG, Thompson JT, Debanne SM, Rowland DY (1986) Prognostic factors in vitrectomy for epiretinal membranes of the macula. Ophthalmology 93:602–610CrossRefPubMed

31.

McDonald HR, Verre WP, Aaberg TM (1986) Surgical management of idiopathic epiretinal membranes. Ophthalmology 93:978–983CrossRefPubMed

32.

Marco Günther KV (2014) Mathematische Modellbildung und simulation. Wiley-VCH, Berlin

Title: Impact of preoperative visual acuity on Descemet Membrane Endothelial Keratoplasty (DMEK) outcome
Authors: Silvia Schrittenlocher
B. Bachmann
A. M. Tiurbe
O. Tuac
K. Velten
D. Schmidt
C. Cursiefen
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 2/2019
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-018-4193-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Impact of preoperative visual acuity on Descemet Membrane Endothelial Keratoplasty (DMEK) outcome

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2019

Cyanoacrylate glue in an inadvertent trabeculectomy flap tear

Antiplatelet and anticoagulant agents in vitreoretinal surgery: a prospective multicenter study involving 804 patients

Risk of breakage of cryolite glass prosthetic eyes

Validation of dynamic random dot stereotests in pediatric vision screening

Refractive adaptation and efficacy of occlusion therapy in untreated amblyopic patients aged 12 to 40 years

New clinical ultrahigh-resolution SD-OCT using A-scan matching algorithm