ESCRS - FPT06.07 - Effect Of Surgical Indication And Disease Severity On Long-Term Outcomes Of Descemet Membrane Endothelial Keratoplasty

Effect Of Surgical Indication And Disease Severity On Long-Term Outcomes Of Descemet Membrane Endothelial Keratoplasty

Published 2022 - 40th Congress of the ESCRS

Reference: FPT06.07 | Type: Free paper | DOI: 10.82333/zkq4-x177

Authors: Achraf Laouani* 1 , Indrė Vasiliauskaitė 2 , Viridiana Kocaba 3 , Korine van Dijk 1 , Lamis Baydoun 4 , Charlotte Lanser 1 , Demi Lee 1 , Martine J Jager 5 , Gerrit RJ Melles 6 , Silke Oellerich 4

1Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands;Melles Cornea Clinic,Rotterdam,Netherlands, 2Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands;Dept. of Ophtalmology,Leiden University Medical Center,Leiden,Netherlands, 3Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands;Melles Cornea Clinic,Rotterdam,Netherlands;Amnitrans EyeBank,Rotterdam,Netherlands;Tissue and Cell Therapy Group,Singapore Eye Research Institute,Singapore,Singapore, 4Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands, 5Dept. of Ophtalmology,Leiden University Medical Center,Leiden,Netherlands, 6Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands;Melles Cornea Clinic,Rotterdam,Netherlands;Amnitrans EyeBank,Rotterdam,Netherlands

Purpose

To evaluate clinical outcomes and graft survival in a large patient cohort up to 10 years after DMEK based on surgical indication and Fuchs endothelial corneal dystrophy (FECD) severity

Setting

Retrospective cohort study at the Netherlands Institute for Innovative Ocular Surgery

Methods

The cohort included 750 eyes which underwent DMEK for FECD (86%), bullous keratopathy (BK, 9%), and other indications (5%). Based on the modified Krachmer grading, 186 eyes (29%) had moderate FECD (Krachmer grade 3-4) and 440 eyes (68%) advanced FECD (Krachmer grade 5-6). Main outcome measures were best-corrected visual acuity (BCVA), central corneal thickness, endothelial cell density (ECD), endothelial cell loss (ECL), postoperative complication rate, and graft survival

Results

Mean 10-year BCVA was 0.08±0.28 logMAR (n=96) and BCVA remained stable between 5-10 years postoperatively (all P>0.05). Mean ECD was 1136±460 cells/mm2 (n=460) at 5 years and 890±381 cells/mm2 (n=96) at 10 years with an ECL of 56±17% and 66±14%, respectively (P<0.05). Ten-year graft survival rate for the total cohort was 0.85

BCVA and ECD differed at 1-5 years between eyes with different surgical indications (all P<0.05), with FECD eyes having higher 10-year graft survival compared to BK eyes (0.90 vs 0.60, P=0.001). 10-year graft survival was higher in eyes with moderate than advanced FECD (0.94 vs 0.88), and moderate FECD eyes had also better BCVA and ECD outcomes (all P<0.05), except for the difference in 10-year ECD (P=0.39).

Conclusions

Long-term outcomes and graft survival after DMEK were better in FECD than BK eyes and were related to FECD disease severity. Eyes operated for moderate FECD showed the highest graft survival probability and excellent long-term outcomes.