Endothelial survival after DMEK: effect of surgical indication and graft adherence status

Session Details

Session Title: Cornea
Session Date/Time: Sunday 28/02/2016 | 08:30-11:00
Paper Time: 10:18
Venue: MC2 Room
First Author: : J.Peraza-Nieves, MD THE NETHERLANDS
Co Author(s): :    L. Baydoun, MD   L. Ham, PhD   V. Borderie, MD, PhD   I. Dapena, MD, PhD   S. Oellerich, PhD   G. Melles

Abstract Details

Purpose:

To determine endothelial survival and its association with the indication for surgery and/or partial graft detachment in Descemet membrane endothelial keratoplasty (DMEK).

Setting:

1Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; 2Melles Cornea Clinic Rotterdam, The Netherlands; 3Amnitrans Eye Bank, Rotterdam, The Netherlands, 4Department of Ophthalmology, Centre Hospitalier National d’Ophthalmologie des XV-XX, UPMC University of Paris, France, 5Department of Methodology and Statistics, Utrecht University, The Netherlands.

Methods:

A total of 352 eyes were evaluated up to 8 years after DMEK for Fuchs endothelial corneal dystrophy (FECD, n=314), bullous keratopathy (BK, n=31) and failed previous endothelial graft (n=7) of which 314 eyes had complete graft attachment and 38 eyes partial graft detachment (≤1/3 of the graft surface area). Endothelial cell density (ECD) was measured with specular microscopy, Kaplan-Meier survival estimates were based on eyes with endothelial failure. Endothelial survival was followed up to 8 years after DMEK.

Results:

Mean ECD declined to 952 (±366) and 771 (±321) cells/mm2 at 7 and 8 years postoperatively. Higher ECDs were found in FECD than BK eyes (P=.0401) and in eyes with attached than partially detached grafts (P<.0.001). Eleven11 eyes (3.1%) showed endothelial failure within 4 years after DMEK. Overall graft survival probability was 0.96 at 5 and 8 years [Confidence interval (CI) 0.94–0.99]. At 8 years, better survival rates were found in FECD than BK eyes (0.97 (CI [0.95-0.99]) vs. 0.84 (CI [0.70-0.99]); for attached and partially detached grafts these rates were 0.97 (CI [0.95-0.99]) vs. 0.91 (CI [0.82-0.99]).

Conclusions:

Endothelial decay was higher in eyes with a partial graft detachment than in attached grafts and lower in FECD than in BK. Endothelial failure only occurred in eyes with concomitant ocular pathology. These results suggest that DMEK eyes operated on for FECD with a completely attached graft may have an excellent prognosis

Financial Disclosure:

One or more of the authors receives consulting fees, retainer, or contract payments from a competing company