ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1580733
Clinical Outcomes in Imported Endothelium-In Preloaded vs Surgeon-loaded DMEKs in Asian Eyes
Provisionally accepted
- 1Duke-NUS Medical School, Singapore, Singapore
- 2Singapore National Eye Center, Singapore, Singapore
- 3Singapore Eye Research Institute (SERI), Singapore, Singapore
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Purpose: To perform a direct, prospective, comparative analysis of the complications associated with imported preloaded grafts versus surgeon-loaded grafts in Descemet membrane endothelial keratoplasty (DMEK) in Asian eyes.Methods: 20 consecutive preloaded DMEKs were matched by donor age with 40 surgeon-loaded DMEKs, for the indications of Fuchs’ endothelial cell dystrophy (FECD) and pseudophakic bullous keratopathy (PBK). All cases of preloaded and surgeon-loaded DMEKs were by a single surgeon in the Singapore National Eye Centre and utilized endothelium-in pull-through cartridges (CORONET DMEK Endoglide; Network Medical Products, United Kingdom). Imported preloaded grafts were prepared 72 to 96 hours prior to surgery. Main outcome measures were intra-operative complications such as graft tears, extrusion, and high vitreous pressure. Secondary outcome measures were endothelial cell loss and early post-operative complications such as ocular hypertension, graft detachment and rebubbling, up to 6 months post-operatively.Results: Preloaded DMEKs had significantly shorter intra-operative times (26.2 min vs 39.5 min; P < 0.001) than surgeon-loaded DMEKs, but were associated with increased intra-operative risk of conversion to standard injector-DMEK (15% vs 0%; P = 0.033). However, there was no increase in overall intra-operative complications (40% vs 22.5%; P = 0.156), early post-operative complications (35% vs 30%; P = 0.772) and rebubbling rate (5% vs 5%; P > 0.999). Visual outcomes and endothelial cell loss were not significantly different in both groups.Conclusion: In our Asian study cohort of pull-through DMEKs, endothelium-in preloaded DMEKs were significantly faster than surgeon-loaded DMEKs and had comparable clinical outcomes.
Keywords: Descemet membrane endothelial keratoplasty, preloaded grafts, Pull-through, endothelium-in, Intra-operative complications, post-operative complications
Received: 21 Feb 2025; Accepted: 24 Apr 2025.
Copyright: © 2025 Cheong, Wong, Howard, Htoon and Ang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ezekiel Ze Ken Cheong, Duke-NUS Medical School, Singapore, Singapore
Marcus Ang, Duke-NUS Medical School, Singapore, Singapore
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