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Descemet's membrane automated endothelial keratoplasty (DMAEK): visual outcomes and visual quality
  1. Carlindo Da Reitz Pereira1,
  2. Frederico P Guerra2,
  3. Francis W Price Jr1,
  4. Marianne O Price2
  1. 1Price Vision Group, Indianapolis, Indiana, USA
  2. 2Cornea Research Foundation of America, Indianapolis, Indiana, USA
  1. Correspondence to Dr Marianne O Price, Cornea Research Foundation of America, 9002 N. Meridian St, Suite 212, Indianapolis, IN 46260, USA; marianneprice{at}


Background/aims To determine whether the stromal rim that carries the bare endothelial graft in Descemet's membrane automated endothelial keratoplasty (DMAEK) has any effect on final visual outcome or visual quality.

Methods Twenty-four DMAEK eyes and 22 Descemet's membrane endothelial keratoplasty (DMEK) eyes (with no stromal rim) were evaluated for corrected distance acuity, full-field Humphrey visual field (VF) 120-2 and pupil size. The inner and outer diameter of the DMAEK stromal ring was measured from slit lamp photos. Patients completed a questionnaire rating postoperative symptoms and visual complaints. Exclusion criteria were pre-existing glaucoma, retinal pathology or inability to return for postoperative examinations.

Results Median Snellen acuities were comparable between DMAEK and DMEK groups: 20/25 and 20/20-3, respectively. The mean central opening of the DMAEK stromal ring was 5.6×5.5 (range 3.8–6.9) mm. The incidence of VF defects, visual complaints of glare, halos, light sensitivity and night driving difficulties was comparable between groups (all p>0.1). A larger scotopic pupil size (<5.5 mm) was not associated with increased incidence of VF defects in either group (p=0.3).

Conclusions Surprisingly, compared with uniformly thin DMEK grafts, DMAEK grafts with a stromal rim had no increase in VF defects or visual complaints.

  • Descemet's stripping endothelial keratoplasty
  • penetrating keratoplasty
  • DSEK
  • DMEK
  • cornea
  • vision
  • treatment surgery
  • visual perception

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  • Presented at the American Society of Cataract and Refractive Surgery (ARCRS) meeting, Boston, Massachusetts, USA, 11 April 2010, Paper Session 2-P.

  • Competing interests FWP and MOP receive travel grants from Moria, Antony, France.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the IRBCo (

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

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