Effect of surgical indication and preoperative lens status on Descemet membrane endothelial keratoplasty outcomes

Session Details

Session Title: Cornea & Miscellaneous
Session Date/Time: Saturday 22/02/2020 | 08:30-11:10
Paper Time: 09:19
Venue: Auditorium des Ministres.

First Author: R.AlSaady THE NETHERLANDS
Co Author(s): R. Birbal  L. Baydoun  K. van Dijk  I. Dapena  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:

... gains financially from product or procedure presented, ... is employed by a for-profit company with an interest in the subject of the presentation