The Influence Of The Preoperative Central Corneal Thickness On The Postoperative Changes Of Central Corneal Thickness, Visual Acuity And Endothelial Cell Density After Descemet Membrane Endothelial Keratoplasty (Dmek)

Published 2023 - 41st Congress of the ESCRS

Reference: FP10.05 | Type: Free paper | DOI: 10.82333/z3hg-6k57

Authors: Johanna Wiedemann* ¹ , Mert Mestanoglu ¹ , Tarek Windheuser ¹ , Silvia Schrittenlocher ¹ , Mario Matthaei ¹ , Claus Cursiefen ² , Björn Bachmann ¹

¹Department of Ophthalmology,University Hospital of Cologne,Cologne,Germany, ²Department of Ophthalmology,University Hospital of Cologne,Cologne,Germany;Center for Molecular Medicine ,University Hospital of Cologne,Cologne,Germany

Purpose

To determine the impact of preoperative central corneal thickness (CCT) on the postoperative CCT, endothelial cell density (ECD) and best spectacle-corrected visual acuity (BSCVA) after Descemet membrane endothelial keratoplasty (DMEK) in Fuchs endothelial corneal dystrophy (FECD)

Setting

University Hospital of Cologne, Department for Ophthalmology, Cologne, Germany

Methods

We included 1465 eyes from our prospective DMEK database. All FECD eyes undergoing a DMEK or a triple DMEK between the years 2011-2018 were retrospectively evaluated. Eyes with extracorneal vision limiting diseases were excluded from the analysis, with the exception of eyes with macular degeneration that were excluded only from visual acuity analysis. Outcome measures were changes in CCT, ECD and BSCVA as logMAR. Preoperative and postoperative 3, 6, 12, 24, 36-month follow-up data were recorded and analyzed via SPSS (IBM SPSS Statistics, version 25.0) through application of multilevel models. A p-value less than 0.05 was considered significant.

Results

For every 1 μm increase in preoperative CCT, postoperative CCT increased by 0.178 μm in the entire cohort, by 0.14 μm in pseudophakic DMEK eyes, and by 0.20 μm in triple DMEK eyes. The influence of preoperative CCT on BSCVA at each time point was significant 3 to 24 months, however no longer at 36 months after surgery. Increased preoperative CCT led to a lower ECD after DMEK within the first 6 months. Endothelial cell loss was pronounced immediately postoperatively and increased only slightly thereafter. The higher the preoperative CCT in the entire cohort, the higher the postoperative logMAR visual acuity and the lower the corresponding vision. The postoperative BSCVA was inversely correlated with preoperative CCT in the entire cohort.

Conclusions

Higher preoperative CCT was associated with higher postoperative CCT, lower ECD and lower visual acuity up to 24 months after surgery. Patients with FECD may benefit from an early pseudophakic DMEK or triple DMEK indication. Early surgical decision may be associated with faster visual recovery.