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. 2025 Jan 9;44(8):1010-1021.
doi: 10.1097/ICO.0000000000003758.

Delphi-Based Global Consensus on Adopting Endothelial Keratoplasty: An Endothelial Keratoplasty Learners Group Initiative

Maninder Bhogal  1   2   3   4   5   6   7   8   9   10   11   12   13   14   15   16   17   18   19   20   21   22   23   24   25   26   27   28   29   30 , Nidhi Gupta  2   3 , Ticiano Giobellina  4 , Akira Kobayashi  5 , John Males  6 , Jodhbir S Mehta  3 , Vito Romano  7 , Bruce Allan  8 , Massimo Busin  9 , Claus Cursiefen  10 , Rajesh Fogla  11 , Mark Gorovoy  12 , Yuri McKee  13 , Ellen Koo  14 , Viridiana Kocaba  15 , Luis Fernando Mejia  16 , Aline Moriyama  17 , Sanjay Patel  18 , Nicolas Cesario Pereira  18 , Francis W Price Jr  19 , Christopher J Rapuano  20 , Audrey Talley Rostov  21 , Alain Saad  22 , Namrata Sharma  17 , Allan Slomovic  24 , Gerard Sutton  25 , Mark Terry  26 , Elmer Tu  27 , Peter Veldman  28 , Roberto Pineda 2nd  29 , Pravin K Vaddavalli  30
Affiliations

Delphi-Based Global Consensus on Adopting Endothelial Keratoplasty: An Endothelial Keratoplasty Learners Group Initiative

Maninder Bhogal et al. Cornea. .

Abstract

Purpose: To identify areas of consensus among experts on the performance of endothelial keratoplasty by using a modified Delphi approach, to help create a framework for novice surgeons to adopt these procedures.

Methods: Thirty-one international experts in endothelial keratoplasty participated. Two rounds of electronic survey were followed by a hybrid, virtual meeting. Consensus was set at 75%, and results with agreement between 70% and 75% were deemed as achieving near consensus.

Results: A consensus was reached for 98 statements covering the preoperative, intraoperative, and postoperative aspects of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty/Descemet stripping automated endothelial keratoplasty. Four statements achieved near consensus, and consensus could not be achieved for 11 statements. For DMEK, the panel supported a peel technique to prepare tissue for endothelium out DMEK, implanted via an injector and supported by a near full air/gas fill as a baseline procedure onto which more advanced techniques can be built. DMEK tissue should be marked to ensure correct orientation. An inferior peripheral iridotomy should be used to prevent pupil block when a near full air/gas fill in used in endothelial keratoplasty (EK). Descemet stripping automated endothelial keratoplasty was considered preferable to Descemet stripping endothelial keratoplasty where access to microkeratome preparation was available.

Conclusions: The Delphi process allowed areas of consensus on the performance of EK to be established by a group of international experts. The statements generated are a helpful framework for novice surgeons learning EK. Further research is needed to help determine what specific tomographic features indicate EK, when guttae are considered visually significant and how to approach combined aphakia and endothelial dysfunction.

Keywords: DMEK; DSAEK; DSEK; Delphi concensus; descemets membrane endothelial keratoplasty; endothelial keratoplasty.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

References

    1. Dapena I, Ham L, Melles GR. Endothelial keratoplasty: DSEK/DSAEK or DMEK--the thinner the better? Curr Opin Ophthalmol. 2009;20:299–307.
    1. Pavlovic I, Shajari M, Herrmann E, et al. Meta-analysis of postoperative outcome parameters comparing Descemet membrane endothelial keratoplasty versus Descemet stripping automated endothelial keratoplasty. Cornea. 2017;36:1445–1451.
    1. Hos D, Matthaei M, Bock F, et al. Immune reactions after modern lamellar (DALK, DSAEK, DMEK) versus conventional penetrating corneal transplantation. Prog Retin Eye Res. 2019;73:100768.
    1. Hos D, Tuac O, Schaub F, et al. Incidence and clinical course of immune reactions after Descemet membrane endothelial keratoplasty: retrospective analysis of 1000 consecutive eyes. Ophthalmology. 2017;124:512–518.
    1. Allan BD, Terry MA, Price FW Jr, et al. Corneal transplant rejection rate and severity after endothelial keratoplasty. Cornea. 2007;26:1039–1042.

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