Postitive outcomes in DMEK study

DMEK shows good graft survival and visual outcomes at five years

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Jorge Peraza-Nieves MD
A five-year follow-up study of 500 patients who underwent Descemet membrane endothelial keratoplasty (DMEK) resulted in high graft survival rates, excellent visual outcomes and acceptable corneal endothelial cell loss comparable to other keratoplasty techniques. Jorge Peraza-Nieves MD, Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, The Netherlands, presented the study at the 24th ESCRS Winter Meeting in Marrakech, Morocco. The study involved a consecutive series of 500 eyes of 393 patients who underwent DMEK for Fuchs’ endothelial corneal dystrophy (FECD), bullous keratopathy, failed corneal transplants and other endothelial indications. The series excluded the first ever 25 DMEK cases to take into account the learning curve of the DMEK technique itself. The patients in the study had a mean age of 68 years, 56% were female and 44% were male and 75% of patients were pseudophakic. The main indication for DMEK was FECD (89%). All underwent evaluation of best-corrected visual acuity (BCVA), central endothelial cell density (ECD) and central corneal thickness before, and up to five years after DMEK, Dr Peraza-Nieves said. GOOD GRAFT SURVIVAL AND BCVA At a follow-up of five years, cumulative survival probability was 90%, with higher rates for eyes operated on for FECD (93%) than for other indications (72%). In addition, the mean logMAR BCVA improved from 0.49 preoperatively to 0.06 at one year postoperatively and remained stable at 0.05 at two and five years postoperatively. In addition, at five years postoperatively, BCVA was 20/25 or better in 82% of eyes, 20/20 or better in 54% eyes and 20/18 or better in 15% of eyes. Regarding endothelial cell density, there was initially a steep decline followed by a stable annual decrease similar to that seen after DSAEK. The mean ECD decreased by 37% at six months, by 40% at one year and by 55% at five years postoperatively, Dr Peraza-Nieves said. The main postoperative complication was partial graft detachment, which occurred in 15.8% in the early postoperative period, 9% were detachments of one-third or less of the graft surface and 6.8% were larger detachments. The principal longer-term complications are secondary graft failure in 2.8%, 0.6% occurring within the first year and 2.2% after the first year and allograft rejection in 2.8%, 0.8% occurring within the first year and 2.0% after the first year. In total, re-transplantation was required for 8.8% of the eyes within the study period. An overview of all results of the study by Birbal et al. can be found here. Jorge Peraza-Nieves: peraza@clinic.cat
Tags: Descemet membrane endothelial keratoplasty (DMEK), keratoplasty