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Effect of surgical indication and preoperative lens status on Descemet's membrane endothelial keratoplasty outcomes
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First Author: R.Birbal THE NETHERLANDS
Co Author(s): L. Baydoun L. Ham K. van Dijk M. Jager S. Oellerich G. Melles
Abstract Details
Purpose:
To analyze 6-month results of 1000 consecutive DMEK cases, and to evaluate if outcomes are influenced by surgical indication and preoperative lens status.
Setting:
Retrospective, interventional case series conducted at the Netherlands Institute for Innovative Ocular Surgery.
Methods:
A series of 1000 eyes (738 patients) underwent DMEK for Fuchs endothelial corneal dystrophy (FECD; 85.3%), bullous keratopathy (BK; 10.5%), failed previous transplant (3.7%) or other indications (0.5%). Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD), postoperative complications and re-transplantations.
Results:
At 6 months postoperatively, BCVA outcome did not differ between FECD and BK eyes (P=0.170), or between phakic and pseudophakic FECD eyes (P=0.066). Donor ECD at 6 months postoperatively was similar for phakic and pseudophakic FECD eyes (39%; P=0.852), but higher for BK eyes than FECD eyes (46% versus 39%, P=0.001). Primary and secondary graft failure occurred in 3 (0.3%) and 2 eyes (0.2%), respectively, and 7 eyes developed allograft rejection (0.7%). Eighty-two eyes (8.2%) received re-bubbling for graft detachment and re-transplantation was performed in 20 eyes (2.0%). Re-bubbling rates were higher in BK than in FECD eyes (P=0.022).
Conclusions:
DMEK consistently provides excellent short-term results, with similar high visual acuity levels for both FECD and BK eyes. As preoperative lens status did not influence DMEK outcomes, for phakic FECD eyes with a still relatively clear crystalline lens, it may be preferable to preserve the lens in a selected group of younger patients, who may still benefit from their residual accommodative capacity.
Financial Disclosure:
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