Mid-term results of Descemet's membrane endothelial keratoplasty (DMEK): 2 to 6 year clinical outcome

Session Details

Session Title: Cornea Surgical I

Session Date/Time: Monday 15/09/2014 | 08:00-10:30

Paper Time: 09:20

Venue: Boulevard B

First Author: : L.Ham THE NETHERLANDS

Co Author(s): :    V. Liarakos   K. van Dijk   W. Tse   L. Baydoun   I. Dapena   G. Melles

Abstract Details

Purpose:

To evaluate the mid term outcomes of Descemet membrane endothelial keratoplasty (DMEK).

Setting:

Retrospective study of non-randomized prospectively collected data at a tertiary referral center.

Methods:

DMEK was performed in 300 consecutive eyes of 248 patients for Fuchs endothelial dystrophy, bullous keratopathy or previous corneal transplant failure. All eyes were followed regularly for at least 2 years (2-6 years). Best corrected visual acuity (BCVA), endothelial cell density (ECD) and central corneal thickness (CCT) were evaluated before surgery, at 6, 12 and 24 months after DMEK and annually thereafter. Post-operative complications were described.

Results:

98.3% of eyes reached a BCVA of ≥20/40 (0.5), 78.7% ≥20/25 (0.8), 45.7% ≥20/20 (1.0) and 14.8% ≥20/17 (1.2) within the first 6 months after surgery, and remained stable up to 6 years. Donor ECD showed a decrease of 34.5% at 6 months and 42.8% at 2 years with an additional decrease of 8-10% per year up to 6 years. CCT decreased by 21.6% from 671µm (±99µm) before surgery to 525µm (±52µm) at 6 months and did not change thereafter. The most frequent complication was (partial) graft detachment observed in 14.7% (44/300) of cases, 11% (33/300) required a re-transplantation. The majority of complications appeared in the first 6 months, apart from allograft rejection episodes (2 out of 6 incidents needed re-transplantation), and late-onset graft failures (2 cases) that appeared 2 to 3 years later. Rebubbling rate was 4% (12/300).

Conclusions:

Fast and near complete visual recovery achieved at 6 months remains stable for up to 2-6 years. Endothelial cell density decreases in a stable slow rate after the first 6 months. Complications are very rare after the first 6 months.

Financial Interest:

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