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Quarter Descemet's membrane endothelial keratoplasty (Quarter-DMEK) for Fuchs' endothelial corneal dystrophy: 6 month clinical outcome and in vitro cell migration patterns

Poster Details

First Author: L.Baydoun THE NETHERLANDS

Co Author(s):    V. Zygoura   A. Miron   L. Ham   I. Dapena   S. Oellerich   G.      

Abstract Details


To assess the in vivo clinical outcome of the first series of Quarter-Descemet membrane endothelial keratoplasty (Quarter-DMEK), a potential hybrid technique between ’descemetorhexis only’ and conventional, circular DMEK and to investigate in vitro central and peripheral corneal endothelial cell migration from Quarter-DMEK grafts.


The Netherlands Institute for Innovative Ocular Surgery / Tertiary referral center.


Prospective interventional case series of 12 eyes of 12 patients with central Fuchs endothelial corneal dystrophy that underwent Quarter-DMEK, i.e. transplantation of one quadrant of a full-diameter DMEK graft. Eyes were evaluated for best corrected visual acuity (BCVA), endothelial cell density (ECD) and its complications up to 6 months postoperatively. In vitro endothelial cell migration was evaluated by light microscopy at standardized time intervals on Quarter-DMEK grafts obtained from 10 corneas ineligible for transplantation but with intact and viable endothelial cells.


At 6 months postoperatively, all eyes reached a BCVA of ≥20/40 (≥0.5), 11/12 (92%) of ≥20/25 (≥0.8) and 6/12 (50%) of ≥20/20 (≥1.0). Mean central ECD decreased from 2867 (±161) cells/mm2 before to 1255 (±514) cells/mm2 at one month, 1058 (±455) cells/mm2 at 3 months and 968 (±427) cells/mm2 at 6 months after surgery. Re-bubbling was performed in 4/12 eyes (33%). Corneas mainly cleared from the radial cut graft edges and remained longer edematous at the round graft edge. In-vitro endothelial cell migration was observed from the radial cut graft edges, but not from the far peripheral area.


Quarter-DMEK may be a feasible procedure that allows for visual outcomes similar to conventional DMEK. The higher drop in ECD within the first month could result from more extensive endothelial cell migration. In vitro endothelial cell migration from Quarter-DMEK grafts occurs along the radial cut edges with a decrease in migration activity towards the corneal far periphery. Hence, endothelial cells from the far periphery may not contribute to corneal clearance of the adjacent bare area after Quarter-DMEK surgery. If longer term outcomes would resemble those of conventional DMEK, Quarter-DMEK may potentially quadruple the availability of endothelial grafts.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented

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