Outcomes After Repeat Descemet Membrane Endothelial Keratoplasty
Published 2023 - 41st Congress of the ESCRS
Reference: FP10.08 | Type: Free paper | DOI: 10.82333/yfx1-eb35
Authors: Achraf Laouani* 1 , Indre Vasiliauskaite 1 , Mohamed Ghaly 1 , Gerrit RJ Melles 2 , Silke Oellerich 3
1Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands;Melles Cornea Clinic,Rotterdam,Netherlands, 2Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands;Melles Cornea Clinic,Rotterdam,Netherlands;Amnitrans EyeBank ,Rotterdam,Netherlands, 3Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands
Purpose
To evaluate clinical outcomes after repeat Descemet membrane endothelial keratoplasty (DMEK) for technical graft failure (TGF) and for secondary graft failure (SGF).
Setting
Retrospective cohort study at the Netherlands Institute for Innovative Ocular Surgery.
Methods
A group of 49 eyes (48 patients, mean age 66±11 years) which underwent DMEK either for TGF (i.e. persistent graft detachment, n=24) or for SGF (i.e. late endothelial graft failure, n=25) were included in this study. Mean time between primary and repeat DMEK was 13±13 months for the TGF group and 48±33 months for the SGF group. Initial surgery indications for DMEK were Fuchs endothelial corneal dystrophy (FECD, 80%) and (pseudophakic) bullous keratopathy (PBK/BK, 20%). Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD), and graft survival.
Results
LogMAR BCVA improved from 0.92±0.6 before to 0.20±0.3 at 1-year after repeat DMEK with better outcomes for TGF eyes as compared to SGF eyes (0.14±0.2 vs 0.26±0.4, P=0.046). ECD decreased from 2618±172 cells/mm2 before to 1247±422 cells/mm2 at 1-year postoperatively, with no difference between groups (P>0.05). Within 5-years after repeat DMEK, 6 eyes developed another graft failure. 5-year graft survival probability after repeat DMEK was 87% for the total group with significantly better survival probability for TGF than for SGF eyes (100% vs. 75%, P=0.010). Eyes with FECD as primary surgery indication had a 5-year survival rate after repeat DMEK of 92% vs. 65% for PBK/BK eyes (P=0.042).
Conclusions
Repeat DMEK is a feasible procedure that gives excellent outcomes especially when performed for technical graft failures in the early period after primary DMEK. Longer term graft survival probability after repeat DMEK is comparable for eyes with FECD as initial surgery indication while eyes with PBK/BK also have an elevated risk of graft failure after repeat DMEK.