Surgeon Preference for Endothelial Keratoplasty Techniques

Purpose: To examine barriers and facilitators to adoption of Descemet membrane endothelial keratoplasty (DMEK) for treatment of endothelial dysfunction. Methods: Anonymous electronic surveys were emailed to surgeons ordering corneal transplant tissue in the past 18 months from 2 eye banks in the United States (US). Results: Of 365 surgeons emailed, 118 (32%) completed the survey. Most respondents were located at an urban site (59%), were in private practice (64%), and had been in practice for >10 years (53%). Participants performing DMEK (n = 70) were more likely to have been in practice for <= 10 years than those not performing DMEK (56% vs. 35%, respectively, P = 0.03). Among respondents not performing DMEK (n = 48, 41%), the most frequently reported barriers were technical difficulty (n = 30, 63%), a lack of experience (n = 29, 60%), low surgical volume (n = 20, 42%), and risk of postoperative complications (n = 19, 40%). Most (n = 46, 96%) respondents not performing DMEK were interested in doing so, with the following reported as helpful resources: wet laboratory courses (n = 35, 73%), eye bank-prepared tissue: preloaded/prestripped (n = 32, 67%), back-up tissue in case of inadvertent graft damage (n = 29, 60%), higher surgical volume to support the learning curve (n = 28, 58%), and surgical mentorship (n = 22, 46%). Only a minority wanted more data to highlight superiority over other EK procedures (n = 12, 25%). Conclusions: There is substantial interest in learning to perform DMEK among the surgical community. Barriers identified in this survey may be addressed to help surgeons increase DMEK adoption.