Superior Versus Temporal Approach in Descemet Membrane Endothelial Keratoplasty

center dot PURPOSE: To compare superior vs temporal approach in patients who underwent Descemet membrane endothelial keratoplasty (DMEK). center dot DESIGN: Monocentric, prospective nonmasked study. center dot METHODS: A prospective analysis of 53 DMEKs between January and September 2013 was performed at the Charite-Universitatsmedizin Berlin. Only DMEK cases with an incision size of 2.3 mm and with at least 1 month of follow-up were included. The surgically induced astigmatism (SIA), changes in corneal aberrations and in spherical equivalent, visual acuity, endothelial cell density, and complications were evaluated. center dot RESULTS: Visual acuity improved significantly (0.70 +/- 0.39 logMAR vs 0.32 +/- 0.31 logMAR after 1 month (n = 48), 0.19 +/- 0.15 logMAR after 3 months (n = 46), and 0.16 +/- 0.17 logMAR after 6 months (n = 47) (P < .001)) regardless of the approach. SIA was significantly lower after temporal than after superior approach (1.42 +/- 0.91 diopters [D] [n = 13] vs 0.81 +/- 0.68 D [n = 13], P = .038). Change in total root mean square of all aberrations (RMS) (P = .046) at 6 mm pupil diameter, and change in total RMS (P = .019), third-order aberrations (P = .007), and fourth-order aberrations (P = .041) at 4 mm pupil diameter, demonstrated significantly lower results after temporal compared to superior approach. A higher rate of eyes after temporal approach underwent at least 1 rebubbling (39.1% vs 26.7%, P = .252). The endothelial cell density (P = .053) and the change in spherical equivalent (P = .145) did not differ significantly. center dot CONCLUSIONS: The temporal approach induces significantly less SIA and corneal aberration. There are no significant differences between superior and temporal approach according to the change in spherical equivalent, visual acuity, and endothelial cell density. The need for rebubbling is higher using the temporal approach. (C) 2015 by Elsevier Inc. All rights reserved.