Laser–Assisted Corneal Surgery, Cuts Endothelial Cell-Loss Rate

Femtosecond DMEK may help extend graft survival duration, an investigation shows.

Femtosecond-enabled Descemet membrane endothelial keratoplasty (F-DMEK) has lower endothelial cell-loss rates than manual DMEK, and may help extend the duration of graft survival for patients with Fuchs’ endothelial dystrophy (FED), according to research published in Cornea. The report shows an excellent safety and efficacy profile could be maintained for 5 years.

The retrospective study took into account patients with FED and cataract who underwent either F-DMEK or M-DMEK with cataract extraction at Toronto Western Hospital and the Kensington Eye Institute, between September 2014 and September 2016. The main outcome measures were visual acuity, graft detachment, graft survival, and endothelial cell loss.

A total of 16 eyes of 15 patients (mean age, 63.9±9.3 years; 56.2% women and 43.8% men) underwent F-DMEK and 42 eyes of 37 patients (68.9±8.6 years; 61.9% women and 38.1% men) underwent M-DMEK. The preoperative best spectacle-corrected visual acuity (BSCVA) was 0.50±0.33 logMAR in the F-DMEK group and 0.64±0.49 logMAR in the M-DMEK group. The average follow-up duration was 57.1±12.4 months for the F-DMEK group and 58.5±17.3 months for the M-DMEK group. 

The researchers found that the rates of primary failure (0% vs 9.5%; P =.567), secondary failure (0% for both), and graft rejection (0% vs 7.1%; P =.533) were not significantly different between the groups. 

They also observed similar levels of improvement in BSCVA in the F-DMEK and M-DMEK groups (0.32±0.27 logMAR and 0.35±0.44 logMAR, respectively; P =.165) and found that this improvement persisted at 2, 3, 4, and 5 years and at the last follow-up visit. 

For the safety outcomes, the team found that the rates of graft detachment and rebubbling were significantly lower in the F-DMEK group (6.25%) than in the M-DMEK group (33.3%; P =.035). They also found that the cell-loss rates were significantly lower in the F-DMEK group than in the M-DMEK group for up to 2 years during the follow-up period. The difference was 8.6% at 1 year (P =.023), 11.8% at 2 years (P =.021), 7.6% at 3 years (P =.088), 5.8% at 4 years (P =.256), 13.6% at 5 years (P =.169), and 7.1% at the final follow-up visit (P =.341).

“[With F-DMEK], the early lower rebubble rate, primary failure, and reduction in ECL seem to be maintained over a longer term follow-up and could benefit future graft survival,” according to the researchers. “Larger studies may help provide conclusive information.”


Sorkin N, Gouvea L, Din N, et al. Five-year safety and efficacy of femtosecond laser-assisted Descemet membrane endothelial keratoplasty Cornea. Published online March 18, 2022. doi:10.1097/ICO.0000000000003019