Real-World Outcomes of DMEK: A Prospective Dutch registry study

Abstract

PURPOSE: This study analyzed real-world practice patterns, graft survival, and outcomes of Descemet membrane endothelial keratoplasty (DMEK) in the Netherlands.DESIGN: Population-based interventional clinical study.METHODS: In this prospective registry study, all consecutive primary DMEK procedures registered in the Netherlands Organ Transplant Registry were identified. Short-term graft survival and outcomes of primary transplants for Fuchs' endothelial dystrophy (FED) were analyzed using Kaplan-Meier survival curves with log-rank test and Cox regression. Linear mixed model analyses were used for best spectacle-corrected visual acuity (BSCVA), spherical equivalent, hyperopic shift, and endothelial cell density.RESULTS: 752 DMEKs were identified between 2011 and 2018. In 90% of cases, the indication for DMEK was FED. Graft survival measured 87% at 3 months, 85% at 6 months, 85% at 1 year, and 78% at 2 years. DMEK procedures after 2015 showed better survival compared to previous years (Hazard ratio [ 0.4; P < .001). Baseline BSCVA in primary transplants with FED measured on average 0.45 logarithm of the minimum angle of resolution (logMAR) (95% confidence interval [CI], 0.41-0.49), and significantly improved (overall P < .001) to 0.17 logMAR (95% CI, 0.14-0.21) at 3 months, 0.15 logMAR (95% CI, 0.11-0.18) at 6 months, 0.12 logMAR (95% CI, 0.08-0.16) at 1 year, and 0.08 (95% CI, 0.05-0.12) at 2 years. At 3 months, a hyperopic shift of D0.36 diopters (P < .001) was observed and endothelial cell loss measured 33%.CONCLUSION: Our findings provide real-world support that DMEK is an effective treatment for FED with respect METHODSGRAFT REGISTRY AND DATA COLLECTION: Data for this multicenter prospective registry study was obtained from the NOTR, a prospective national database founded

Effects of uncomplicated Descemet membrane endothelial keratoplasty on the central retinal thickness

“…0.8 decimal) at the 6-month follow-up. This swift and excellent visual recovery has previously been described for DMEK [48][49][50][51]. With 0.38 log-MAR (approx.…”

Hyperosmolar Eye Drops for Diurnal Corneal Edema in Fuchs’ Endothelial Dystrophy

“…3 To resolve corneal edema and to restore visual function, Descemet membrane endothelial keratoplasty (DMEK) is the gold standard surgical treatment with excellent long-term outcomes in advanced Fuchs' dystrophy. [4][5][6][7] Non-surgical approaches to treating early-morning associated corneal edema reach from hyperosmolar eye drops to hair dryers. [8][9][10][11][12] Hyperosmolar eye drops are recommended by the American Academy of Ophthalmology's patient portal.…”

Outcomes of the Advanced Visualization In Corneal Surgery Evaluation (ADVISE) trial; a non-inferiority randomized control trial to evaluate the use of intraoperative OCT during Descemet membrane endothelial keratoplasty

“…[7][8][9] Despite these advantages the rate of postoperative adverse events (e.g., graft detachment requiring rebubbling) for DMEK is relatively high with a reported prevalence of ranging between 2% and 82% for rebubbling and 3% and 11% for primary graft failure. [9][10][11][12] These adverse events necessitate secondary surgical interventions and are associated with a lower graft viability and survival. 10 The causes of graft detachment and primary graft failure are considered multifactorial and can be divided into donor, patient, and surgical factors.…”

“…[9][10][11][12] These adverse events necessitate secondary surgical interventions and are associated with a lower graft viability and survival. 10 The causes of graft detachment and primary graft failure are considered multifactorial and can be divided into donor, patient, and surgical factors. 10,13 The primary focus of current research considers modifications of surgical techniques to prevent these complications.…”