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Hybrid Descemet's membrane endothelial keratoplasty (H-DMEK): results of a donor insertion pull-through technique using donor stroma as carrier

Poster Details

First Author: J.Woo SINGAPORE

Co Author(s):    H. Htoon   D. Tan                 

Abstract Details


To evaluate the outcomes and complications of Hybrid Descemet membrane endothelial keratoplasty (H-DMEK) using the EndoGlide Ultrathin DSAEK pull-through device and donor stroma as carrier.


Singapore National Eye Centre, Singapore


This was a prospective, interventional case series. Hybrid DMEK was performed using the EndoGlide pull-through technique and donor stroma as carrier in 86 eyes by a single surgeon. Eyes with diagnoses of aphakic or pseudophakic bullous keratopathy (BK), Fuchs endothelial corneal dystrophy (FECD), failed grafts and iridocorneal endothelial syndrome were included. Complex cases included those with tube shunts, aphakia, aniridia, previous vitrectomy, keratoplasty or combined with intraocular lens exchange. Main outcome measures included best corrected visual acuity (BCVA), endothelial cell loss and complications such as postoperative graft detachment and primary graft failure.


Of 86 eyes from 80 patients (mean age 63.4 +/- 15.3 years), 44.2% (N=38) had BK, 27.9% (N=24) had FECD and 23.3% (N=20) had failed grafts. DMEK was performed in 38 (44.2%) complex cases and combined with cataract surgery in 25 eyes. BCVA of 6/12 or better at 6 months was attained in 76% of patients. Four eyes required rebubbling and 1 case of primary graft failure was observed. The overall endothelial cell loss was 32.2% +/- 20.5% at 6 months, which improved from 37.2% +/- 20.9% to 24.2% +/- 17.5%, comparing the first 40 and next 46 cases (p=0.01).


Hybrid DMEK offers a controlled technique of donor preparation and insertion, which may be useful especially in complicated eyes. More studies are needed to confirm the long term endothelial cell loss and graft survival of this donor insertion technique.

Financial Disclosure:

gains financially from product or procedure presented

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