Abstract
Purpose :
Descemet membrane endothelial keratoplasty (DMEK) is a standard procedure to replace dysfunctional corneal endothelium. Here we examined the outcome after DMEK in a multicenter study.
Methods :
A retrospective blinded analysis was performed on data from seven DMEK centers in Germany. We examined Best Corrected Visual Acuity (BCVA, logMAR), corneal thickness, endothelial cell density (ECD) of graft and recipient, the number of re-bubblings as well as graft failure rate. Follow-up was performed until twelve months after DMEK.
Results :
3200 eyes were included, the average patient age was 66 years. Twelve months after DMEK, we observed increased BCVA (0,7±0,5 logMar preoperatively vs. 0,2±0,4 logMar postoperatively; p=0,001), decreased ECD (2465±259 cells/mm2 preoperatively vs. 1587±433 cells/mm2 postoperatively; p<0,001), and decreased corneal thickness (629±82 µm preoperatively vs. 519±53 µm postoperatively; p=0,001). The same differences were also found in the isolated examination of each centre. Over the period of six-twelve months after DMEK, ECD decreased and pachymetry increased significantly (p<0,001 and p=0,026). No re-bubbling was performed in 69% (n=2121), one re-bubbling in 25% (n=777) of cases (3x: 5%, 4x:1%, 5x:1%). Graft failure occurred in 3% (n=67) of all eyes. There was no correlation between graft failure and the number of DMEKs in each Centre.
Conclusions :
DMEK has become the new gold standard for treating corneal endothelial dysfunction in Germany. This is reflected by the fact that the success rate of the procedure was independent of the number of grafts performed in the individual centres. DMEK is a safe procedure leading to improved visual acuity while maintaining a low risk of graft failure. On the long term, we observed a slight but significant decrease in ECD, and an increase in corneal thickness. Increased corneal thickness had no negative influence on BCVA.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.