Multicenter Early Experience of Preloaded Descemet Membrane Endothelial Keratoplasty With Endothelium-Inwards Technique With Dextran-Free Preservation Media

Purpose: To investigate the clinical outcomes of patients treated with preloaded Descemet membrane endothelial keratoplasty (DMEK) with endothelium-inwards fashion stored in dextran-free preservation media. Methods: This study (audit number: 11,392) involved a clinical retrospective analysis of consecutive patients with Fuchs Endothelial Corneal Dystrophy or Bullous Keratopathy at 2 tertiary eye centers. All tissues were stripped using a standard DMEK stripping technique (SCUBA), preloaded with the endothelium facing inwards, stored and shipped in a dextran-free preservation media from the Venice Eye Bank, Italy to Liverpool, United Kingdom and Vicenza, Italy for subsequent surgeries. The main outcome measures included rebubbling rate, best-corrected visual acuity (BCVA), and endothelial cell loss over a 12-month period. Results: Sixty-five eyes of 62 patients were analyzed. At 12 months postoperation, the cumulated mean BCVA improved significantly to 0.25 6 0.29 logarithm of the minimum angle of resolution from a preoperative BCVA of 0.84 6 0.55 logarithm of the minimum angle of resolution (P, 0.05), whereas a 33.8% rebubbling rate was recorded with an overall endothelial cell loss of 44.1%. Conclusions: Preloaded endothelium-in DMEK grafts preserved in dextran-free media seem safe and clinically effective, with encouraging outcomes in visual acuity and detachment rates. These results support the feasibility of this approach and highlight the need for prospective controlled trials to confirm its advantages over dextran-based methods.