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Purpose <p>Analyzing experience-related changes and procedural standardization in DMEK using liquid-bubble preparation technique.</p> Methods <p>In this retrospective single-center study, 2929 eyes underwent DMEK between 2014 and 2024. The first and last 50 DMEK procedures for Fuchs endothelial corneal dystrophy performed by seven surgeons were compared (Block 1 vs. Block 2). Outcomes included surgical time, intraoperative complications, rebubbling, repeat DMEK, corrected distance visual acuity (CDVA), central corneal thickness (CCT), and endothelial cell density (ECD) up to 12&#xa0;months.</p> Results <p>Mean graft preparation time decreased by 30% (<i>p</i> = 0.013). Mean surgical duration decreased significantly over time in both isolated DMEK and Triple-DMEK procedures across all surgeons, with operative times reduced by 26.3% and 21.8%, respectively (all <i>p</i> ≤ 0.001). Preparation-related complications declined (33% vs. 18%; <i>p</i> &lt; 0.01), as did intraoperative graft turning (22.9% vs. 10.6%; <i>p</i> &lt; 0.001) and repeat DMEK rates (10.9% vs. 4.9%; <i>p</i> = 0.005). Rebubbling rates remained unchanged (32.9% vs. 30.3%; <i>p</i> = 0.63) but were associated with lower 12-month ECD (<i>p</i> &lt; 0.001). Postoperative graft turning was also associated with reduced ECD (<i>p</i> = 0.02). Despite lower donor ECD in Block 2 (<i>p</i> &lt; 0.001), 12-month ECD and endothelial cell loss did not differ between blocks.</p> Conclusions <p>Liquid-bubble DMEK was associated with improved efficiency and reduced complication rates over time. These temporal changes were observed during a period of increasing surgical experience and progressive procedural standardization. Long-term endothelial outcomes remained stable and largely independent of individual surgeons, while rebubbling and graft turning were the main determinants of endothelial cell loss.</p>

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Learning curve and procedural standardization in liquid-bubble DMEK: impact on preparation efficiency, complication rates, and endothelial cell survival

  • 期刊论文

  • 发表日期：

    2026年7月29日

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  • Claire Walker,
  • Peter Szurman,
  • Nuria Perez,
  • Karl T. Boden,
  • Tristan Früh,
  • Berthold Seitz,
  • Fabian Norbert Fries,
  • Annekatrin Rickmann

摘要

Purpose

Analyzing experience-related changes and procedural standardization in DMEK using liquid-bubble preparation technique.

Methods

In this retrospective single-center study, 2929 eyes underwent DMEK between 2014 and 2024. The first and last 50 DMEK procedures for Fuchs endothelial corneal dystrophy performed by seven surgeons were compared (Block 1 vs. Block 2). Outcomes included surgical time, intraoperative complications, rebubbling, repeat DMEK, corrected distance visual acuity (CDVA), central corneal thickness (CCT), and endothelial cell density (ECD) up to 12 months.

Results

Mean graft preparation time decreased by 30% (p = 0.013). Mean surgical duration decreased significantly over time in both isolated DMEK and Triple-DMEK procedures across all surgeons, with operative times reduced by 26.3% and 21.8%, respectively (all p ≤ 0.001). Preparation-related complications declined (33% vs. 18%; p < 0.01), as did intraoperative graft turning (22.9% vs. 10.6%; p < 0.001) and repeat DMEK rates (10.9% vs. 4.9%; p = 0.005). Rebubbling rates remained unchanged (32.9% vs. 30.3%; p = 0.63) but were associated with lower 12-month ECD (p < 0.001). Postoperative graft turning was also associated with reduced ECD (p = 0.02). Despite lower donor ECD in Block 2 (p < 0.001), 12-month ECD and endothelial cell loss did not differ between blocks.

Conclusions

Liquid-bubble DMEK was associated with improved efficiency and reduced complication rates over time. These temporal changes were observed during a period of increasing surgical experience and progressive procedural standardization. Long-term endothelial outcomes remained stable and largely independent of individual surgeons, while rebubbling and graft turning were the main determinants of endothelial cell loss.