Dmeks In Young Adults: Clinical Outcomes Of Descemet Membrane Endothelial Keratoplasty Performed In Patients ≤ 30 Years Of Age

To evaluate the indications and clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed in young adults, i.e. ≤ 30 years.

DMEKs are commonly performed in older adults for endothelial dysfunction secondary to Fuchs' endothelial dystrophy and pseudophakic bullous keratopathy. DMEKs are rarely performed in the younger adult age group and indications and outcomes for the procedure may vary in this subset of patients.

We conducted a retrospective, single-centre, observational cohort study of the DMEK surgeries performed between January 2015 and October 2022 in patients ≤ 30 years of age with 12 months of follow-up. Best corrected visual acuity (BCVA), central corneal thickness (CCT), graft survival, and intra- and postoperative complications were recorded.

Sixteen DMEKs were performed in 14 patients with a median age of 24.5 (19-30). Indications included endothelial dystrophy (8, [50%]), endothelial failure in a penetrating keratoplasty graft (3, [19%]), bullous keratopathy secondary to glaucoma surgery (2, [13%]), penetrating injury with corneal decompensation (2, [13%]) and cosmetic iris implants leading to corneal decompensation (1, [6%]). Median BCVA improved from 6/36 (6/6-HM) to 6/12 (6/5-PL), and median CCT declined from 660 (±89) μm to 537 (±77) μm at 1 year. Seven of the 16 DMEKs (44%) required re-bubbling due to partial detachment. Two patients underwent repeat endothelial keratoplasty within the 12-month follow-up. Graft survival rate was 80% (12/15) at 1 year.

Patients under 30 years of age with endothelial dysfunction requiring DMEK surgery represent a unique subset of patients. Excluding endothelial dystrophies, these patients often have co-existing ocular pathology which limit visual potential. Nevertheless, DMEK appears to be well tolerated in this age group and can yield significant visual improvements. Longer follow-up is required to determine long-term outcomes, especially important in this younger group of patients.