Descemet’s membrane endothelial keratoplasty is the predominant keratoplasty procedure in Germany since 2016: a report of the DOG-section cornea and its keratoplasty registry

Abstract

Background/aimsThis retrospective multicentric panel study provides absolute numbers, types of and indications for corneal transplantation in Germany from 2011 to 2021 and sets them into the international context.MethodsA questionnaire was sent to the 104 German ophthalmologic surgery departments and 93 (89%) provided their data.ResultsThe number of reported keratoplasties more than doubled from 2011 (n=4474) to 2021 (n=8998). Lamellar keratoplasties (49% posterior (n=2883), 4% anterior (n=231)) surpassed penetrating keratoplasty (PKP, 47%, n=2721) for the first time in 2014. Since 2016, Descemet’s membrane endothelial keratoplasty (DMEK) has become the predominant keratoplasty procedure in Germany. Its number increased by 1.5-fold from 3850 (2016) to 5812 (2021). Main indications in 2021 were Fuchs’ endothelial corneal dystrophy (FECD, 43%), pseudophakic corneal decompensation (12%), repeated keratoplasty (11%), infections (7%), keratoconus (6%) and corneal scarring (4%, others: 9%). The PKP percentage decreased from 70.2% in 2011 (n=3141) to 31.7% in 2021 (n=2853). Descemet’s stripping (automated) endothelial keratoplasties (DSAEKs) decreased to 1% in 2021 (n=74). 98.6% of all posterior lamellar keratoplasties were DMEKs in Germany in 2021. The number of deep anterior lamellar keratoplasties (DALKs) remained comparable from 2011 (n=269) to 2021 (n=251, 2.8%).ConclusionMain indications for corneal transplantation in Germany (2021) were FECD and pseudophakic corneal decompensation. DMEK is by far the predominant corneal transplantation procedure since 2016 followed by PKP, whose absolute number decreased only slightly during the decade from 2011 to 2021. DALK proportions remain low, but stable, whereas DSAEK decreased annually and plays a minor role in Germany.Trial registration numberNCT03381794.

Review for special issue: Corneal lamellar surgery: Present outcomes and future perspectives

“…[ 50 ] The same trend is observed in Germany, where DMEK will represent 98.6% of posterior lamellar surgeries, associated with a decrease from 70.2% to 31.7% in PKP between 2011 and 2021. [ 5 ] In the USA, performed lamellar keratoplasties also dramatically increased, with DSAEK being the most performed lamellar surgery in 2014. [ 51 ] The proportion of lamellar keratoplasties also increased in China in the past decade, but PKP remains the predominant surgical technique, representing 56.9% al all keratoplasties.…”

“…DMEK is becoming increasingly popular internationally, especially in Europe, and can also be used in difficult conditions of the anterior segment of the eye. [ 5 ] In DMEK, only the Descemet’s membrane and the corneal endothelium are transplanted.…”

“…Alongside technical advances in PKP,[ 4 ] new lamellar techniques have also emerged. [ 5 ] These techniques, which focus on transplanting precise layers of the cornea, offer undeniable advantages for patients. [ 6 ] To ensure a high level of quality, eye banks are more than ever involved in the selection and preparation process for these lamellar surgeries.…”

3D-Kartierung der DMEK-Abhebungsfläche aus OCT-Scans des vorderen Augensegmentes mit klinischen Anwendungen

“…Die Descemet-Membran-Endothel-Keratoplastik (DMEK) stellt mittlerweile den größten Anteil der Hornhauttransplantationen in Deutschland dar [1]. Die häufigste Komplikation nach DMEK ist die inkomplette Transplantatanlage, vor allem in der frühen postoperativen Phase [2,3].…”

“…In einer Sekundäranalyse prospektiver Daten von Teilnehmern mit Fuchs-Endotheldystrophie und unkomplizierter (Triple-)DMEK verglich unsere Arbeitsgruppe die Fläche der Transplantatabhebung, die mithilfe des zuvor beschriebenen Netzwerks quantifiziert wurde [19]. Dabei wurde zwischen Abhebung von weniger und mehr als 1 1 ⁄3 3 der Transplantatfläche bei der poststationären Kontrolle ca. 2 Wochen nach Operation unterschieden.…”