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Korine van Dijk, Silke Oellerich, Ham Lisanne, Sorcha Ni Dhubhghaill, Lamis Baydoun, Gerrit Melles; Risk factors associated with high endothelial cell density decrease after Descemet membrane endothelial keratoplasty. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3813.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate which parameters may affect endothelial cell density (ECD) decrease after Descemet membrane endothelial keratoplasty (DMEK) by comparing eyes in the low versus high quartile of ECD decrease over a follow-up period of four years.
For 351 eyes of 275 patients who underwent DMEK for Fuchs endothelial corneal dystrophy (FECD), donor ECD decrease was evaluated up to four years postoperatively. Eyes with a postoperative ECD decrease in the lower quartile at all available follow-up moments were assigned to Group 1 (n=51), and those in the upper quartile to Group 2 (n=42). Multinominal regression was used to assess which covariates were related to the different patterns of ECD decrease.
Mean ECD decrease as compared to preoperative donor ECD for the entire study group was 33 (±16)%, 36 (±17)%, and 52 (±18)% at 1, 6 and 48 months postoperatively. ECD decrease of Group 1 was 12 (±7)%, 13 (±6)%, and 26 (±8)% at respectively 1, 6 and 48 months postoperatively, and 59 (±10)%, 64 (±9)%, and 75 (±5)% in Group 2. Partial graft detachment (Odds ratio (OR) 15.41, 95% confidence interval (CI) [15.22,15.61], P<0.01), donor death cause (cardiovascular/stroke vs cancer: OR 2.33, CI [2.03, 2.63], P<0.01), postoperative complications other than graft detachment (OR 1.78, CI [1.69,1.87], P<0.01) and severity of preoperative FECD (OR 1.77, CI [1.42, 2.13], P<0.01) showed the strongest relation with different patterns of ECD decrease.
DMEK eyes with a completely attached graft and operated in an early stage of FECD may show the lowest ECD decrease postoperatively.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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