Real-world outcomes of DMEK: a prospective Dutch national registry study

Session Details

Session Title: Surgical Cornea: Keratoplasty & Corneal Grafts

Session Date/Time: Sunday 23/09/2018 | 14:00-16:00

Paper Time: 14:12

Venue: Room A3, Podium 3

First Author: : M.Dickman THE NETHERLANDS

Co Author(s): :    S. Dunker   M. Veldman   F. van den Biggelaar   T. Berendschot   B. Winkens   R. Nuijts     

Abstract Details

Purpose:

To study the real-world outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) in the The Netherlands.

Setting:

Prospective multicenter study with national registry data (The Netherlands Organ Transplantation Registry, NOTR).

Methods:

Data on all consecutive primary DMEKs for Fuchs endothelial dystrophy between 2011 and 2018 was analyzed, with a maximal follow-up of 3 years. Primary outcome was graft survival, which was analyzed using Kaplan-Meier survival curves and Cox regression analysis. Secondary outcomes were: best corrected visual acuity (BCVA), endothelial cell density (ECD), spherical equivalent (SE), and complications, which were analyzed using linear mixed models.

Results:

A total of 373 primary DMEKs were analyzed. Overall three year graft survival measured 84%, and increased significantly with time (p=0.01). BCVA improved significantly at three months compared to baseline (0.51 vs. 0.39 LogMAR, p<0.001), and from three to six months (0.39 vs. 0.23 logMAR, p<0.001), stabilizing thereafter. Compared to the donor graft, ECD decreased significantly 3 months following surgery (2710 vs. 1760 cells/mm^2, p<0.001). SE did not change significantly 3 months following surgery compared to baseline. Rebubbling and primary graft failure were both recorded in 15% of cases.

Conclusions:

Our real-world outcomes indicate overall DMEK graft survival is lower compared to the literature. This is due to a high incidence of primary graft failure. However, graft survival improved significantly with time, suggesting a learning curve on a national level is involved. ECD loss in our study was comparable with values reported in the literature. Although DMEK resulted in significant improvement in BCVA up to six months after surgery, visual outcomes in our study fall short of previous reports, even in patients without vision-limiting comorbidities.

Financial Disclosure:

-