Graft survival and clinical outcomes of Descemet membrane endothelial keratoplasty: long-term results

Abstract

Purpose: The aim is to report long-term graft survival rates, clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK).Methods: In this study 150 eyes, that underwent DMEK whether for Fuchs endothelial corneal dystrophy (FECD) or for bullous keratopathy (BK), surveilled for 7 years at 6 time-points to evaluate graft survival rates and clinical outcomes of post-corneal transplantation.Results: Overall, the estimated survival probability of 95% con dence interval at 7 years of post-DMEK was 0.58 (0.72-0.77) and the survival probabilities of eyes operated for FECD (0.53) were higher than eyes operated for BK (0.42) (Log Rank 26.87, [p=0.197]). Post-transplant eyes with FECD achieved better visual acuity levels than eyes with BK (p=0.006). Primary graft failure occurred in 11.3% eyes. Secondary graft failure rate was 9.3%, and allograft rejection rate was 4.7%.Conclusion: Although DMEK is effective, safe in long-term, visual results and graft survival rates are better in cases with FECD.

Ability of routinely collected clinical factors to predict good visual results after primary Descemet membrane endothelial keratoplasty: a cohort study

“… NS Birbal 2020 [ 11 ] 393 mixed 5 y Multi. NS NS NS < 0.0001 Besek 2022 [ 12 ] 150 mixed 7 y Multi. 0.009 NS NS NS Gund 2021 [ 13 ] 463 mixed 12 mo Multi.…”

“…Like us, four observed that an older age predicted worse final BCVA [ 2 , 3 , 18 , 20 ]. However, one found no association [ 11 ] and another reported that a younger age predicted worse final VA [ 12 ]. The importance of age was noted by two studies as moderate and small [ 3 , 20 ].…”

“…Since all studies were quite similar in terms of the independent variables that were included, the discrepancies between them may reflect the duration since DMEK was performed. Specifically, the five studies (including ours) that showed associations with older age examined cases 6–24 months after DMEK [ 2 , 3 , 18 , 20 ], whereas the study that failed to find an association involved 5-year post-DMEK patients [ 11 ], and the study showing an association with younger age focused on patients 7 years after DMEK [ 12 ]. The latter two studies may be complicated by selection bias due to the tendency of geriatric patients to have a poorer BCVA in general than younger patients and to be lost to follow-up more often.…”

“…Three of four studies on donor age also did not find an association with final VA [ 5 , 12 , 14 ]. One was also a multivariate analysis [ 12 ].…”

“…All have some limitations: one included patients with corneas at both the early and end stages of FECD (i.e. the preoperative VAs ranged from very low to almost normal [ 5 ]); others examined variables that are not measured during the standard preoperative ophthalmological assessment before DMEK (anterior surface irregularities [ 3 , 21 ] and anterior corneal haze [ 25 , 26 ]); and many examined a mixture of indications rather than FECD only [ 5 – 8 , 10 – 14 , 16 , 18 – 20 , 22 , 23 ], which are driven by different pathophysiologies [ 27 – 29 ] and can influence the final best corrected VA (BCVA) [ 12 , 18 , 20 ]. Most importantly, none systematically assessed a large array of routinely recorded pre/perioperative demographic and clinical factors for their ability to predict final BCVA after DMEK in FECD patients with explanatory multivariate analysis.…”