Descemet membrane endothelial keratoplasty: analysis of clinical outcomes of patients with 8–10 years follow-up

Abstract Purpose This study aimed to evaluate the clinical outcomes up to 10 years after Descemet membrane endothelial keratoplasty (DMEK). Methods In this retrospective, consecutive, single-center case series the medical files of eyes which have received DMEK between 2009 and 2012 for the treatment of endothelial dysfunction was evaluated regarding follow-up time and clinical outcomes. Annual examinations of best-corrected visual acuity (BCVA), endothelial cell density (ECD), central corneal thickness (CCT) of 66 eyes which fulfilled the criterion of a minimum of 8 years follow-up were analyzed. Results BCVA improved from 0.55 ± 0.37 logMAR (n = 54) to 0.15 ± 0.11 (n = 47) in eyes without ocular comorbidities one year after DMEK (p < 0.001), and remained stable up to 10 years after DMEK. Mean ECD decreased to 744 ± 207 cells/mm2 (n = 39) after 9 years, and to 729 ± 167 cells/mm2 (n = 21) after 10 years, respectively. CCT decreased from 650 ± 67 μm before DMEK to 525 ± 40 μm (n = 56) after 1 year, increasing slowly to 563 ± 40 µm (n = 39) after 9 years, and to 570 ± 42 µm (n = 21) after 10 years, respectively. Graft failure occurred in 4 of 66 eyes after year 8. These 4 eyes required repeat DMEK after 101–127 months. Conclusion This study shows the long-term outcomes in a small subset of DMEK grafts. Visual acuity remained stable in spite of slowly increasing corneal thickness and diminishing endothelial cell density during the 10-year period after DMEK.

Visual acuity and endothelial cell density following Descemet membrane endothelial keratoplasty (DMEK)

Archivos de la Sociedad Española de Oftalmología (English Edition) ◽

10.1016/j.oftale.2012.03.003 ◽

2011 ◽

Vol 86 (12) ◽

pp. 395-401

Author(s):

I. Dapena ◽

L. Dapena ◽

M. Dirisamer ◽

L. Ham ◽

G.R.J. Melles

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Cell Density ◽

Air reinjection and endothelial cell density in Descemet membrane endothelial keratoplasty: Five-year follow-up

Journal of Cataract & Refractive Surgery ◽

10.1016/j.jcrs.2014.04.023 ◽

2014 ◽

Vol 40 (7) ◽

pp. 1116-1121 ◽

Cited By ~ 62

Author(s):

Matthew T. Feng ◽

Marianne O. Price ◽

Jalee M. Miller ◽

Francis W. Price

Keyword(s):

Endothelial Cell ◽

Cell Density ◽

Endothelial Cell Density After Descemet Membrane Endothelial Keratoplasty: 1 to 5-Year Follow-up

American Journal of Ophthalmology ◽

10.1016/j.ajo.2012.06.025 ◽

2012 ◽

Vol 154 (4) ◽

pp. 762-763 ◽

Cited By ~ 26

Author(s):

Lamis Baydoun ◽

C. Maya Tong ◽

Winhou W. Tse ◽

Heng Chi ◽

Jack Parker ◽

...

Keyword(s):

Endothelial Cell ◽

Cell Density ◽

Endothelial Cell Density After Descemet Membrane Endothelial Keratoplasty: 1- to 3-Year Follow-up

American Journal of Ophthalmology ◽

10.1016/j.ajo.2010.01.030 ◽

2010 ◽

Vol 149 (6) ◽

pp. 1016-1017 ◽

Cited By ~ 17

Author(s):

Lisanne Ham ◽

Isabel Dapena ◽

Jacqueline Van Der Wees ◽

Gerrit R.J. Melles

Keyword(s):

Endothelial Cell ◽

Cell Density ◽

Descemet membrane endothelial keratoplasty (DMEK): clinical results of precut versus surgeon-cut grafts

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-020-04901-7 ◽

2020 ◽

Vol 259 (1) ◽

pp. 113-119

Author(s):

Doreen Koechel ◽

Nicola Hofmann ◽

Jan D. Unterlauft ◽

Peter Wiedemann ◽

Christian Girbardt

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Cell Density ◽

Failure Rate ◽

Graft Failure ◽

Descemet Membrane ◽

Median Change

Abstract Purpose This study aims to investigate possible differences in clinical outcomes between precut and surgeon-cut grafts for Descemet membrane endothelial keratoplasty (DMEK). Methods 142 consecutive patients who underwent DMEK were included in the study. 44 patients received precut tissues, and 98 patients received surgeon-cut tissues. Precut grafts were allocated to the patient by the German Society for Tissue Transplantation if available. We compared the outcomes of both groups for changes in visual acuity, central corneal thickness, endothelial cell density, re-bubbling rate, and graft failure rate. Results Patients who received precut tissues experienced similar increase in visual acuity (median change 0.4 logMAR) and decrease of corneal swelling (median change 132 μm) compared with those who received surgeon-cut tissues (median VA change 0.3 logMAR, p = 0.55, CCT change 118 μm, p = 0.63). There was no statistical difference in endothelial cell density (1436 vs. 1569 cells/mm2, p = 0.37), re-bubbling (32% vs. 35%, p = 0.85), and graft failure rate (5% vs. 1%, p = 0.23). No primary graft failure occurred in the group of precut grafts. Conclusion Both methods lead to comparable results for visual acuity, corneal deswelling, endothelial cell density, and re-bubbling rate. A previously described higher graft failure rate for precut tissues could not be confirmed in our study. Thus, we do not see medical reasons against the use of precut tissues. There are several advantages of precut DMEK tissues over surgeon-cut tissues, especially the prevention of graft loss during preparation in the operating theater.

Outcomes after Descemet membrane endothelial keratoplasty over a period of 7 years at a tertiary referral center: endothelial cell density, central corneal thickness, and visual acuity

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-021-05152-w ◽

2021 ◽

Author(s):

Tarek Bayyoud ◽

Faik Gelisken ◽

Jens Martin Rohrbach ◽

Gunnar Blumenstock ◽

Karl Ulrich Bartz-Schmidt ◽

...

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Cell Density ◽

Central Corneal Thickness ◽

Corneal Thickness ◽

Descemet Membrane ◽

Group 2 ◽

Group 1

Abstract Purpose To better assess clinical trajectories of patients with or without ocular comorbidity after Descemet membrane endothelial keratoplasty. Background: To report on the outcomes of eyes with differing starting conditions following surgery. Design: Retrospective study at a University Eye Hospital. Participants: 361 eyes separated into group 1 (n=229; eyes with endothelial disease only) and group 2 (n=132; eyes with additional ocular comorbid conditions, such as herpetic eye disease 18/132 (13.6%), glaucoma 16/132 (12.1%), dry age-related macular degeneration 14/132 (10.6%), epiretinal membranes 10/132 (7.6%), and wet age-related macular degeneration 9/132 (6.8%)). Methods Consecutive eyes that underwent Descemet membrane endothelial keratoplasty over a follow-up period of up to 7 years at a tertiary referral center were reviewed. Main outcome measures were best-corrected visual acuity, postoperative complications, graft survival, central corneal thickness, and endothelial cell density. Results Postoperative best-corrected visual acuity at year 1 improved in both groups significantly (Wilcoxon signed rank test: group 1, p =.002; .63 to .23 logMAR; group 2, p <.001; 1.15 to .87 logMAR) with a group difference in favor of group 1 (p =.009, Mann-Whitney-Wilcoxon). A decrease of the endothelial cell density and central corneal thickness was noted at postoperative year 1 for both groups (paired t-tests (group 1, p <.001; group 2, p =.045) and paired t-tests (group 1, p <.001; group 2, p =.003). Complications were less common, and graft longevity was superior in group 1. Conclusion Eyes with different starting conditions might experience a visual improvement and benefit from surgery. Descemet membrane endothelial keratoplasty is a valid treatment for endothelial disorders in manifold of eyes. Further long-term studies are required.

Visual Quality and Subjective Satisfaction in Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) versus Descemet Membrane Endothelial Keratoplasty (DMEK): A Fellow-Eye Comparison

Journal of Clinical Medicine ◽

10.3390/jcm10030419 ◽

2021 ◽

Vol 10 (3) ◽

pp. 419

Author(s):

Josep Torras-Sanvicens ◽

Irene Blanco-Domínguez ◽

José-María Sánchez-González ◽

Rahul Rachwani-Anil ◽

Juan-Felipe Spencer ◽

...

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Quality Assessment ◽

Cell Density ◽

Case Series ◽

Visual Quality ◽

Background: To analyze objective and subjective visual quality differences between descemet membrane endothelial keratoplasty (DMEK) and ultra-thin descemet stripping automated endothelial keratoplasty (UT-DSAEK) with a paired contralateral-eye design. Methods: A cross-sectional, comparative, and observational case series study between DMEK and UT-DSAEK were presented. Visual acuity, refractive status and corneal quality assessment were compared between both endothelial keratoplasty techniques. The sample consisted of 20 eyes (10 patients) diagnosed with Fuchs endothelial corneal dystrophy. All measurements were performed preoperatively and at six months after surgery. Analyzed data included the measurement of objective scattering index, modulation transfer function, Strehl ratio, and optical quality assessment (OQAS) values. Contrast sensitivity, subjective patient satisfaction, visual acuity, tomography, pachymetry, endothelial cell count, and refraction status were also analyzed. Results: Objective and subjective visual quality variables had similar results among UT-DSAEK and DMEK procedures. Statistically significant differences favoring DMEK against UT-DSAEK were found in endothelial cell density (658.80 ± 139.33 and 1059.00 ± 421.84 cells/mm2, respectively), pachymetry (621.20 ± 33.74 and 529.70 ± 30.00 µm, respectively), and follow-up (45.50 ± 24.76 and 15.50 ± 8.43 months, respectively). Conclusions: UT-DSAEK and DMEK revealed no differences in terms of objective and subjective visual quality. However, DMEK showed a faster recovery during the follow-up, increased endothelial cell density, lower pachymetry, and a more anatomical posterior keratometry against UT-DSAEK in this case series paired-eye study.