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Claus Cursiefen, Ludwig Heindl, Bjoern Bachmann, Kathrin Laaser, Stephan Riss, Friedrich Kruse; Immune Rejection After Isolated Transplantation of Descemet’s Membrane and Endothelium (DMEK). Invest. Ophthalmol. Vis. Sci. 2011;52(14):1155.
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Novel lamellar surgical techniques allow for isolated replacement of diseased corneal tissue. In DMEK, recipient’s Descemet and endothelium are removed and replaced by an allograft consisting of donor Descemet’s membrane and endothelium only. We analyzed the incidence of immune reactions after DMEK.
All patients having undergone DMEK at our Department from June 2009 until November 2010 were prospectively evaluated for signs and symptoms of an endothelial immune reaction. Patients were examined immediately after surgery, at one week, 4 weeks, 2 months, 5 months, 12 months and thereafter every 6 months. At each exam, the graft was examined biomicroscopically and BCVA was tested.
Overall, 130 patients with a minimum follow-up of 3 months were included in the study. DMEK was performed for Fuchs endothelial dystrophy or pseudophacic bullous keratopathy. Mean follow-up was 9.4 ± 4.9 months. All patients were still under (at least low-dose) topical steroid therapy. No patient reported on any typical symptoms of endothelial immune reaction. In no patient were any classical signs of an endothelial immune reaction observed.
Early follow-up data suggest that the incidence of endothelial immune reactions after isolated transplantation of Descemet’s membrane and endothelium is at least not worse compared to DSAEK or penetrating keratoplasty. These findings are in line with animal experimental data on the immunogenicity of different corneal layers.
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