Relationship between the donor and donor cornea characteristics and post-surgery responses of the graft endothelial parameters after DMEK

Session Details

Session Title: Presented Poster Session: Cornea: Surgical

Venue: Poster Village: Pod 3

First Author: : V.Trnková CZECH REPUBLIC

Co Author(s): :    D. Spirka   O. Vlasak   E. Smrckova   Z. Hlinomazova              

Abstract Details

Purpose:

We evaluated changes in endothelial cell parameters in patients after Descemet membrane endothelial keratoplasty (DMEK) in order to assess whether donor- and tissue-related parameters correlated with short- and medium- term changes in the endothelial cell density (ECDen) and hexagonality (ECHex). The aim of this effort is maximize the surgery success and include the donor information into donor-recipient matching process.

Setting:

European Eye Clinic Lexum Brno, Czech Republic National Cell and Tissues Centre Inc., Brno, Czech Republic

Methods:

We studied the clinical outcome of the same cohort of 75 consecutive DMEK eyes for which we matched the donor and tissue information available in National Cell and Tissue Centre Inc. in Brno. The 75 cases evaluated were reflect consecutive DMEK surgical procedures performed at our clinic between October 2014 and December 2016. Retrospective analysis was performed between December 2014 and December 2017. Simple linear regression analysis and logistic regression analysis were used to evaluate how donor- and tissue-related parameters affect endothelium parameters after the surgery. For all statistical tests, a significance level of α = .05 was used.

Results:

The ECDen decreased by 33±17% during three months after DMEK and stabilized after 12 months at 45±10%. ECHex decreased by less than 5%. Grafts with higher ECHex showed significantly lower decrease of ECDen. The donor or recepient age, days to graft expiration date or double procedure (DMEK+PCIOL) did not significantly affect ECHex or ECDen. The graft´s ECDen and ECHex were significantly related to their rate of change after the surgery. The rebubling carried in 14 cases (19%) was associated with significantly lower ECDen values 1,3,6,9 and 12 months after surgery but the difference was less than 15%.

Conclusions:

We have analyzed a number of other factors in an effort to differentiate predictors of ECDen and ECHex change after the surgery. We found that endothelial loss significantly did not affect the age of the donor or the recipient and procedure leads to satisfactory results even in advanced age (even above 80 years). On the other hand, the quality of the donor cornea is a significant factor, expressed in preoperative density and hexagonality of cells, where grafts with preoperatively lower parameters show considerably worse prognosis. Also, performing re-bubbling was shown to greatly speed up the reduction in ECDen and ECHex.

Financial Disclosure:

None