Three-Year Outcomes of Tri-Folded Endothelium-In Descemet Membrane Endothelium Keratoplasty with Pull-Through Technique

Abstract Purpose To report the 3-year outcomes of tri-folded, endothelium-in Descemet membrane endothelial keratoplasty (DMEK) using bimanual pull-through delivery technique. Design Interventional case series Methods In this single center study, 153 consecutive eyes undergoing DMEK for various indications (Fuchs endothelial corneal dystrophy (FECD) n=111; bullous keratopathy (BK) n=24; failed grafts n=18) were included. DMEK grafts were loaded into a disposable cartridge in tri-folded, endothelium-in configuration and delivered using bimanual pull-through technique. Main outcome measures were graft preparation and unfolding times, best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD) and graft survival. Results Mean graft preparation time was 5.9±1.1 minutes; and mean graft unfolding time was 2.9±0.9 minutes. Excluding eyes with comorbidities, logMAR BSCVA improved significantly from baseline preoperative values of 0.92±0.58 to 0.02±0.07at 1 year (p Conclusions Tri-folded, endothelium-in DMEK requires minimal time for graft unfolding, the surgical step considered most challenging by majority of surgeons. Visual outcomes and complication rates are not adversely affected by the modification of surgical technique.