Methods  In this retrospective case review, 5 DMEK (4 patients) performed at Doheny Eye Institute from July 2011 through April 2012 were identified. Donor DMEK grafts were prepared with SCUBA technique intra-operatively. Patient follow-up ranged from 1 to 8 months. Fifteen patients underwent DSEK with at least 3 months of follow-up since July 2011. Preoperative and postoperative best corrected visual acuity (BCVA), manifest refraction, comorbid conditions, and complications were recorded.

Results  The mean age at DMEK surgery was 70 years (range, 64 to 74 years); 4 eyes had Fuch’s endothelial dystrophy and cataract, 1 eye had pseudophakic bullous keratopathy (PBK). The mean age at DSEK was 73 years (range, 61 to 81 years); 6 patients had DSEK combined with cataract extraction, 9 patients had DSEK alone for PBK. By Snellen acuity, average visual angle improvement after DMEK was 3.7 (range 2 to 5, median 3.3). Four patients who underwent DMEK and cataract extraction achieved BCVA at 1 month after surgery. The patient who underwent DMEK for PBK achieved BCVA at 3 months after surgery. One patient had partial DMEK graft dehiscence and was successfully re-bubbled at 1 week after surgery. For patients underwent DSEK, average visual angle improvement was 3.3 (range 2 to 4.5, median 2.8). Three patients achieved BCVA at 2 months, 6 patients at 3 months, and 5 patients at 4 months after surgeries. Two patents had to be re-bubbled within 1 week of DSEK surgery due to partial graft dehiscence. DMEK patients achieved at least comparable BCVA if not better.

Conclusion   DMEK procedure allows faster recovery of BCVA. The remaining donor corneal stroma can potentially be used for anterior lamellar keratoplasty and benefit more patients.