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Takahiko Hayashi, Wei Zhang, Deniz Hos, Silvia Schrittenlocher, Viet Nhat Hung Le, Sebastian Siebelmann, Mario Matthaei, Björn Bachmann, Felix Bock, Claus Cursiefen; Descemet Membrane Endothelial Keratoplasty (DMEK) in vascularized high-risk eyes. Invest. Ophthalmol. Vis. Sci. 2021;62(8):985.
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Although DMEK has lower rates of immune reaction in non-vascularized low-risk eyes, the outcome of DMEK in vascularized eyes, has been unknown. Therefore, the aim of this study was to analyze the clinical outcome of DMEK in vascularized high-risk eyes.
This retrospective single-center consecutive study included the patients after DMEK which were selected from the prospective Cologne DMEK Database between 2012 and 2017 at University of Cologne, Germany. This study was performed in accordance with the tenets of the Declaration of Helsinki, and the protocol was approved by the local ethical review committee (14-373). The clinical outcomes were evaluated from the medical record.; best corrected visual acuity (BCVA; converted to logarithm of the minimum angle of resolution [logMAR]), central corneal thickness (CCT), endothelial cell density (ECD), rebubbling, cystoid macular edema (CME), immune reactions, and graft failure are evaluated. In addition to the standard ophthalmic examinations, neovascularization (NV) was graded from the slit-lamp pictures in a standardized fashion, as previously described.
In this study, 24 eyes of 24 patients were selected (mean age, 65.0 years; mean follow-up duration, 14.8 months [6–36 months]), which included 14 vascularized eyes after failed PK, nine vascularized eyes with long-standing bullous keratopathy, and one vascularized eye with chemical burn. There was no primary graft failure in any case. The BCVA improved from 1.60 ± 1.02 logMAR, preoperatively, to 0.47 ± 0.37 logMAR, 12 months postoperatively (p < 0.001). The CCT decreased from 824 ± 193 μm, preoperatively, to 544 ± 48 μm, 12 months postoperatively (p = 0.001). The donor corneal endothelial cell density (ECD) decreased from 2,272 ± 723 cells/mm2, preoperatively, to 1,570 ± 279 cells/mm2, 12 months postoperatively. The total loss of ECD after the surgery was 40.7 % ± 13.0 %. Eight of 24 eyes (33.3 %) required rebubbling. There was no cystoid macular edema during the follow-up in this case series. Immune reactions occurred in one of 24 eyes (4.2 %) after DMEK. Interestingly, the NV score significantly improved from 2.00 ± 0.49 quadrants to 1.53 ± 0.50 quadrants (p = 0.014, Wilcoxon test). The representative picture is shown in Figure 1.
DMEK could be a good option to treat endothelial dysfunction with vascularized high-risk eyes successfully.
This is a 2021 ARVO Annual Meeting abstract.
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