ANALYSIS OF OBJECTIVE AND SUBJECTIVE OUTCOMES IN DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY (DMEK) AFTER 3 YEARS OF TRANSPLANTATION.

Changes in different corneal parameters occur in DMEK, such as endothelial cell loss (ECL), corneal thickness and corneal power. This study aims to assess and compare the objective and subjective outcomes of this technique.

Department of Cornea and External Diseases, Clinic Hospital of Valladolid, Valladolid, Spain.

A retrospective study was carried out in 19 patients diagnosed with Fuchs’s Endothelial Dystrophy (FED) or pseudophakic bullous keratopathy who underwent DMEK during 2019. Firstly, results in ECL between those who underwent only DMEK and DMEK combined with cataract surgery (phaco-DMEK) were compared.

Moreover, in patients diagnosed of mild and moderate FED and operated from one eye (both DMEK and phaco-DMEK), central corneal thickness (CCT), Total Corneal Refractive Power (TCRP), Simulated Keratometry (SimK) and Spherical Equivalent (SE) were compared between the operated eye and the contralateral eye (considered diseased).

Finally, all patients were asked to score their degree of satisfaction (0: absolutely dissatisfied, 10: totally satisfied).

ECL in all DMEKs had a mean of central endothelial cell count of 1367±654.7. Percentage ECL was similar in the DMEK alone group (n=10) compared with phaco-DMEK (n=9) at 3 years (54.57% ±26.1 vs 49.01%±22; p=0.63).

In patients diagnosed of FED and operated from one eye (n=12), a negative difference in CCT could be observed in the operated eye compared with the contralateral eye (-100.09µm±44.1; p<0.001). Difference in TCRP remained similar in both eyes (-0.67D±1.63; p=0.14), as well as in SimK (-0.5D±0.80; p=0.041), and in SE (-0.067D±2.77; p=0.9). Difference in SE showed a minimum of -3.75D and a maximum of +5.50D.

Subjective level of average satisfaction was 8.24±1.37 over 10.

There was not a significantly different degree of ECL between patients who received only DMEK and phaco-DMEK after 3 years of transplant.

It is paramount to know the degree of change in the cornea after this type of transplant, in order to achieve the greatest possible emmetropization of the patient. Despite the small size of the sample, a tendency to decrease in corneal thickness can be observed, and a change in corneal power can be deduced, which must be taken into account for the calculation of the intraocular lens.  All the same, patients were highly satisfied 3 years after surgery.