Posters

Five year graft survival and rejection episode rates with DMEK vs DSEK, and the effect of donor/recipient sex matching

Poster Details

First Author: M.Price USA

Co Author(s):    F. Price Jr                    

Abstract Details

Purpose:

The primary purpose of this study was to determine whether the lower rejection risk seen with Descemet membrane endothelial keratoplasty (DMEK) results in a 5-year graft survival advantage relative to Descemet stripping endothelial keratoplasty (DSEK). The secondary purpose was to determine whether donor sex or donor/recipient sex matching influences the rejection episode rate or graft survival rate with DSEK or DMEK.

Setting:

Price Vision Group, USA

Methods:

This study reviewed the outcomes of a consecutive series of 2017 cases (1312 DSEK and 705 DMEK) performed by 13 surgeons to treat Fuchs endothelial corneal dystrophy and included the surgeons' first cases. The main outcome measures rejection episodes, graft failure or replacement for any and all reasons, and endothelial cell loss over a 5-year follow up period. Survival rates and relative risk were calculated with Kaplan Meier and proportional hazards analysis, which took loss to follow up into consideration.

Results:

The cumulative 5-year risk of rejection episodes was significantly lower with DMEK (2.6% vs. 7.9% with DSEK, relative risk, 0.29; 95% confidence interval 0.16-0.53) even though topical corticosteroids were reduced early in 25% of the DMEK cases. The 5-year graft survival rates were 93% with both DSEK and DMEK, p=0.86. Only 5 of 113 total graft failures were classified as rejection. The 5-year endothelial cell loss was 48 ± 20% with DMEK and 47 ± 20% with DSEK, p=0.22. Graft rejection episode and survival rates were not significantly influenced by donor sex or donor/recipient sex matching.

Conclusions:

The 5-year graft survival rates were comparable with DMEK and DSEK. DMEK had a significantly reduced risk of immunologic rejection, but few rejection episodes resulted in graft failure within 5 years with either DSEK or DMEK. Sex matching the donor and recipient did significantly affect rejection episode or graft survival rates.

Financial Disclosure:

None