TWO YEARS OF EXPERIENCE IN DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY OUTCOMES AT A TERTIARY REFERRAL CENTER

To explore the outcomes of DMEK surgery for management of corneal endothelial disorders over two years at tertiary referral center, shedding light on its clinical efficacy and patient safety.

Department of Ophthalmology, Centro Hospitalar e Universitário de Lisboa Central, a tertiary referral center in Portugal.

We performed a retrospective analysis of surgical outcomes in patients who underwent DMEK between November 2020 and March 2023 at the Department of Ophthalmology, Centro Hospitalar e Universitário de Lisboa Central. We collected demographic data and surgical indications. Our primary outcome measures included postoperative best-corrected visual acuity (BCVA), endothelial cell count (ECC), and graft adherence. Secondary outcomes encompassed the assessment of postoperative complications, as well as the necessity for anti-hypertensive eye drops.

We collected data on 51 eyes from 47 patients. Among these, 34 eyes belonged to female patients (66.7%), with a mean patient age of 64 years (SD=11.5) at the time of surgery. The average follow-up duration was 19 months.  The primary causes of endothelial dysfunction were Fuchs endothelial dystrophy in 31 eyes (60.8%), bullous keratopathy in 19 eyes (37.3%), and posterior polymorphous corneal dystrophy in one eye (2%). Four eyes had previously undergone Descemet Stripping Automated Endothelial Keratoplasty, and 46 eyes (90.2%) had prior cataract surgery. Initial best-corrected visual acuity (BCVA) significantly improved from 0.9 ± 0.5 logMAR to 0.1 ± 0.1 logMAR at the last follow-up (p<0.001). The mean endothelial cell count at 6 months post-surgery was 1404.7 cells/mm² (SD=406.5), representing a mean decrease of 40% from lenticule cell count (SD=19). Postoperative BCVA showed no significant correlation with patient age (r= -0.14, CI -0.43;0.16) or initial BCVA (r=-0.11, CI -0.40;0.20).

Minor graft edge detachment was observed in five eyes on SS-ASOCT, which did not necessitate further treatment. The primary complication was partial graft detachment, occurring in 6 eyes (11.8%), all of which were successfully resolved through graft re-bubbling. One patient experienced pupillary block, and graft failure was noted in 2 patients. Additionally, four eyes developed secondary ocular hypertension, requiring anti-hypertensive eye drops.

Our findings align with previous publications from corneal transplantation groups, reaffirming the effectiveness and safety of DMEK for patients with endothelial dysfunction.