Posters

DMEK in Super-Seniors: clinical outcomes of Descemet membrane endothelial keratoplasty performed in patients greater than 90 years old

Poster Details

First Author: P.Dockery USA

Co Author(s): J. Parker   L. Ham   C. Parker   J. Parker   G. Melles        

Abstract Details

Purpose:

To evaluate the clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed in the “oldest old” patients, i.e. ≥ 90 years.

Setting:

Parker Cornea, Birmingham, AL, USA and The Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, The The Netherlands

Methods:

Between the years of 2009 and 2019, 20 consecutive eyes of 17 patients aged ≥ 90 underwent DMEK for endothelial dysfunction. Best corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell density (ECD), graft survival, and intra- and postoperative complications were assessed.

Results:

Except in one case in which the DMEK surgery could not be completed, all operated eyes experienced an improvement in BCVA, although only 50% achieved ≥ 20/40 (0.5) by 1 year postoperatively. One year after surgery, median CCT had declined from 641(+/-161) μm to 480 (+/-34) μm (p<0.001), and median endothelial cell density was reduced by 53%, from 2574 (+/-286) to 1226 (+/-404) cells/mm2. Six of 19 eyes receiving DMEK grafts (32%) developed partial graft detachments requiring re-bubbling. One eye experienced a secondary graft failure at 6 months and underwent repeat endothelial keratoplasty.

Conclusions:

DMEK is technically feasible in the oldest old patients and may yield significant visual improvements. Because clinical follow-up may be difficult for these patients, DMEK may be preferable to Descemet stripping endothelial keratoplasty and penetrating keratoplasty because the risk of suture related issues and allograft reaction/rejection is lower.

Financial Disclosure:

None