Endothelial survival after Descemet's membrane endothelial keratoplasty: effect of surgical indication and graft adherence status

Session Details

Session Title: Cornea: Surgical I

Session Date/Time: Tuesday 08/09/2015 | 08:00-10:30

Paper Time: 09:36

Venue: Room 10

First Author: : L.Baydoun THE NETHERLANDS

Co Author(s): :    L. Ham   V. Borderie   I. Dapena   L. Frank   S. Oellerich   G. Melles     

Abstract Details

Purpose:

To determine endothelial survival up to 7 years and its correlation with the indication for surgery and/or partial graft detachment in Descemet membrane endothelial keratoplasty (DMEK).

Setting:

Netherlands Institute for Innovative Ocular Surgery / Tertiary referral center.

Methods:

A total of 353 eyes were evaluated up to 7 years after DMEK for Fuchs endothelial dystrophy (FED, n=315), bullous keratopathy (BK, n=32) and failed previous endothelial graft (n=6), of which 315 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 and Kaplan-Meier survival estimates were based on endothelial failures.

Results:

ECD decreased to an average of 762 (±265) cells/mm2 at 7 years postoperatively. Higher ECDs were found in FED than BK eyes (P=0.003) and in eyes with attached than partially detached grafts (P=0.014) until 3 years. In 11 eyes (3.1%), that all had concomitant ocular pathology, endothelial failure occurred within four years after DMEK. Overall survival probability was 96.1% at 3 years, and 95.1% at 5 and 7 years. At 3 years, better survival rates were found in FED than BK eyes (97.7% vs. 78.2%, P=0.011), and in attached than partially detached grafts (96.9% vs. 90.7%, P=0.053).

Conclusions:

Until 7 years after DMEK, the average ECD remained above the critical threshold of 500 cells/mm2. Endothelial cell decay was higher in eyes with partial graft detachment than attached grafts and lower in FED than in BK; endothelial failure only occurred in eyes with concomitant ocular pathology. DMEK eyes operated on for FED with a completely attached graft may have an excellent prognosis.

Financial Interest:

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