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

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).

Postoperative graft turning was also associated with reduced endothelial cell density (p = 0.02).

Despite lower donor endothelial cell density in Block 2 (p < 0.001), 12-month endothelial cell density and endothelial cell loss did not differ between blocks.