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New research · Ophthalmology
International ophthalmology · 2d
Cohort studyInternational ophthalmology · 2026

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

Claire Walker, Peter Szurman, Nuria Perez … Annekatrin Rickmann
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OphthalmologyCohort study

Corneal graft preparation time dropped substantially as DMEK surgeon experience grew

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

Claire Walker … Annekatrin Rickmann
International ophthalmology · 2026
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.

n = 2929 eyes
Results

graft prep took less time as surgeons gained experience

Block 1
33%
Block 2
18%
More results

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).

More results

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.

“
Conclusion · 1 of 2

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.

Conclusion · 2 of 2

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.

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