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Quarter-Descemet membrane endothelial keratoplasty (Quarter-DMEK) for Fuchs endothelial corneal dystrophy: 6 months clinical outcome
  1. Vasiliki Zygoura1,2,
  2. Lamis Baydoun1,2,
  3. Lisanne Ham1,2,3,
  4. Vincent J A Bourgonje1,2,
  5. Korine van Dijk1,2,
  6. Jessica T Lie1,3,
  7. Isabel Dapena1,2,
  8. Silke Oellerich1,
  9. Gerrit R J Melles1,2,3
  1. 1 Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
  2. 2 Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
  3. 3 Amnitrans EyeBank Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr Gerrit R J Melles, Netherlands Institute for Innovative Ocular Surgery, Rotterdam 3071AA, The Netherlands; research{at}


Background/aim To assess the 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.

Methods Prospective interventional case series at a tertiary referral centre. Twelve eyes of 12 patients with central Fuchs endothelial corneal dystrophy underwent Quarter-DMEK, that is, transplantation of one quadrant of a full-diameter DMEK graft, and were evaluated for best-corrected visual acuity (BCVA), endothelial cell density (ECD) and complications up to 6 months postoperatively.

Results 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 1 month, 1058 (±455) cells/mm2 at 3 months and 968 (±427) cells/mm2 at 6 months after surgery. Rebubbling was performed in 4/12 eyes (33%) within the first two months.

Conclusions Quarter-DMEK may be a feasible procedure that allows for visual outcomes similar to conventional, circular DMEK. The relatively large drop in ECD within the first month may have resulted from more extensive endothelial cell migration and/or measurement error (at the graft edges). If longer-term outcomes would resemble those of conventional DMEK, Quarter-DMEK may potentially quadruple the availability of endothelial grafts.

  • descemet membrane endothelial keratoplasty
  • quarter-DMEK
  • hemi-DMEK
  • endothelial cell density
  • pachymetry
  • visual acuity
  • cell migration

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  • Contributors Study concept and design, and supervision: LB and GRJM. Acquisition, analysis and interpretation of data: VZ, LB, LH, VJAB and KvD, SO. Drafting of the manuscript: VZ, LB, SO and GRJM. Critical revision of the manuscript for important intellectual content: all authors. Administrative, technical or material support: VJAB, JTL and LH.

  • Competing interests GRJM is a consultant for DORC International/Dutch Ophthalmic USA and SurgiCube International. LB and ID are consultants for DORC International/Dutch Ophthalmic USA.

  • Patient consent Obtained.

  • Ethics approval METC Zuidwest Holland. The study was performed according to the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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