Analysis of different types of anesthesia in descemet membrane endothelial keratoplasty.

Purpose: The purpose of this study is to compare the safety and clinical results of descemet membrane endothelial keratoplasty (DMEK) in topical, peribulbar or general anesthesia.

Methods: This is a retrospective, post hoc matched study of 120 patients having received DMEK surgery with different types of anesthesia (n = 40 topical, n = 40 peribulbar, n = 40 general anesthesia). Endpoint criteria were intraoperative complications, endothelial cell count, central corneal thickness and graft rejection rate, rebubbling rate and best-corrected visual acuity after 1, 3 and 6 months.

Results: The group with topical anesthesia showed more often intraoperative difficulties such as vitreous pressure (p < 0.05), difficult graft unfolding (p = 0.14) and patient restlessness (p = 0.07). However, all three groups achieved comparable functional visual results after 6 months (p = 0.96).

Conclusion: DMEK in topical anesthesia is feasible and shows comparable final visual results but should be restricted to selected cooperative patients and performed by experienced surgeons due to possible higher intraoperative challenges.