Five-year clinical outcomes after Descemet's membrane endothelial keratoplasty (DMEK): results of the first 500 consecutive cases

Session Details

Session Title: Cornea Surgical: Keratoplasties

Session Date/Time: Monday 16/09/2019 | 16:30-18:00

Paper Time: 17:00

Venue: Free Paper Forum: Podium 1

First Author: : r.Birbal THE NETHERLANDS

Co Author(s): :    L. Ham   R. Birbal   S. Ní Dhubhghaill   S. Oellerich   G. Melles                 

Abstract Details

Purpose:

To evaluate the longer-term clinical outcomes and graft survival up to 5 years after Descemet membrane endothelial keratoplasty (DMEK) for the first 500 consecutive cases.

Setting:

Retrospective, interventional case series conducted at the Netherlands Institute for Innovative Ocular Surgery.

Methods:

From a group of 500 eyes (393 patients), which underwent DMEK for Fuchs endothelial corneal dystrophy (FECD), bullous keratopathy, failed corneal transplants and other endothelial indications, clinical outcomes [best-corrected visual acuity (BCVA), central endothelial cell density (ECD), and central corneal thickness] were evaluated before, and up to 5 years after DMEK. Survival probability was calculated and postoperative complications were documented.

Results:

At 5 years postoperatively, 82% of eyes reached a BCVA of ≥20/25 (≥0.8), 54% of ≥20/20 (≥1.0), and 15% of ≥20/18 (≥1.2). Mean ECD decreased by 40(±18)% and 55(±18)%, at 1 and 5 years postoperatively, respectively. Re-transplantation was required for 8.8% of the eyes within the study period. Main postoperative complication was partial graft detachment (15.8%) in the early postoperative period. Principal longer term complications are secondary graft failure (2.8%) and allograft rejection (2.8%). Cumulative survival probability at 5 years was 90%, with higher rates for eyes operated on for FECD (93%) than for other indications (72%).

Conclusions:

At 5 years postoperatively, DMEK showed a high graft survival rate, excellent visual outcomes, an ECD decrease comparable to other keratoplasty techniques and a low complication rate.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented