Perceived difficulties and barriers to uptake of Descemet’s membrane endothelial keratoplasty among surgeons

Sidra Zafar,¹ Jack S Parker,^2,3 Christa de Kort,^3,4 Gerrit Melles,^3,4 Shameema Sikder<sup>1

1</sup>Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA; ²Parker Cornea, Birmingham, AL, USA; ³Netherlands Institute for Innovative Ocular Surgery-United States of America, San Diego, CA, USA; ⁴Melles Cornea Clinic, Rotterdam, Netherlands

Purpose: To determine barriers related to implementation of Descemet’s membrane endothelial keratoplasty (DMEK) among corneal surgeons.
Methods: This was a multicenter survey study of all corneal surgeons who participated in a DMEK wet lab organized by the Netherlands Institute for Innovative Ocular Surgery. Data related to barriers limiting uptake of DMEK surgery, self-perceived levels of competence, and difficulty with different steps of DMEK surgery were analyzed.
Results: The survey response rate was 31% (22 of 72). The most common barrier to uptake of DMEK surgery identified was anxiety related to incorrect insertion of the tissue and the need to regraft (64%, 14 of 22), followed by anxiety related to tissue preparation (50%, eleven of 22). Surgeons also felt anxious regarding the possibility of rebubbling with initial DMEK (41%, nine of 22). Steps related to DMEK graft (76%) preparation, tissue insertion (41%), and graft unfolding (72%) were identified as the most difficult steps to learn by the respondents.
Conclusion: The DMEK learning curve, especially for the novice surgeon, may be shortened by seeking educational resources, including wet labs and surgical videos. Eye banks may facilitate adoption of DMEK by making validated DMEK tissue more accessible to surgeons globally.

Keywords: DMEK, uptake, barriers, difficulties