1. First 25 Descemet Membrane Endothelial Keratoplasty (DMEK) Outcomes for an Experienced DSAEK Surgeon Authors: Victoria Epstein, MS.,DO, Josh Wallsh, MS-III, Robert Schultze, MD

2. Financial Disclosure Authors have no financial interests or relationships to disclose

3. Purpose To determine the endothelial cell mortality and the time course of visual recovery in patients undergoing DMEK.

4. Methods In this retrospective analysis, 25 eyes from 21 patients underwent DMEK by one surgeon having performed over 800 successful previous DSAEK surgeries. Best-corrected visual acuity (BCVA), endothelial cell density (ECD), and complications were assessed at routine post-op follow-ups. Pre-op donor ECD was obtained from Eye Bank records. Donor tissue was pre-stripped by Eye Bank personnel Post-op measurements were determined by specular microscopy.

6. Results Average pre-op BCVA was 20/48 Post-op: 20/54, 20/34, 20/31 and 20/29 at 1- (p=0.06), 6-(p<0.05), 12-(p<0.01), and 24-(p<0.01) weeks, respectively. Average endothelial cell mortality rate was 47.5% and 49.7% at 12- and 24-weeks, respectively (p<0.001). 6 eyes (24%) required at least one rebubbling and 4 eyes (16%) suffered primary graft failure. –2 failures were due to donor inversion and 2 due to traumatic insertion

7. DMEK Endothelial Cell Density and Mortality pre-op vs 12 weeks (3-months) vs 24 weeks (6- months)

8. DMEK Best Corrected Visual Acuity pre-op vs post-op

9. DMEK : % of patients BCVA at 6-weeks, 3-months, 6-months

10. Conclusion DMEK improves BCVA rapidly with continued improvement over the first 6 months. Endothelial cell mortality and complication rate is substantial in early cases despite substantial previous DSAEK surgical experience.