Real-World Outcomes Of Descemet Membrane Endothelial Keratoplasty: Up To 7 Years Of A Single-Center Experience
Published 2024 - 42nd Congress of the ESCRS
Reference: PO751 | Type: Free paper | DOI: 10.82333/86jc-f439
Authors: Rita Teixeira-Martins* 1 , Margarida Ribeiro 1 , Inês Coelho-Costa 1 , Ana Filipa Moleiro 1 , Ana Maria Cunha 1 , Raúl Moreira 1 , Pedro Neves-Cardoso 1 , Luís Torrão 1 , João Pinheiro-Costa 1
1ULS São João,Porto,Portugal
Purpose
Descemet membrane endothelial keratoplasty (DMEK) revolutionizes corneal transplantation by selectively replacing only the diseased endothelial layer with a thin layer of donor Descemet membrane and endothelium. Compared to traditional penetrating keratoplasty (PK), DMEK offers faster visual recovery, superior outcomes, reduced rejection risk, and less astigmatism. Our aim is to evaluate long-term clinical outcomes in order to refine the technique, optimize patient selection and improve postoperative care to enhance DMEK success and durability in tertiary centers.
Setting
Corneal & External Eye Disease Department, ULS São João, Porto, Portugal
Methods
Our center adopted this lamellar technique in 2016 following advancements in surgeons training. We conducted a retrospective, single-center, observational cohort study reviewing DMEK surgeries performed between August 2016 and August 2023. Primary outcome measures included graft survival, best-corrected visual acuity (BCVA) in logMAR scale and central endothelial cell density (ECD). Intraoperative and postoperative complications, as well as the need for subsequent keratoplasties, were considered secondary outcomes.
Results
Between August 2016 and August 2023, our center performed 122 DMEK procedures on 99 patients, with a mean age of 65.91 ± 11.82 years. The majority were female (61.6%). Leading indications were Fuchs dystrophy, pseudophakic bullous keratopathy, corneal decompensation from previous keratoplasties and bullous keratopathy associated with phakic lens. BCVA significantly improved from 0.75 ± 0.26 to 0.24 ± 0.23 in one year (p<0.05). At five years, mean BCVA was 0.44 ± 0.24, and mean ECD was 854.75 ± 218.97 cells/mm2. Mean Annual ECD loss after the first year was 12.9%. Overall graft survival rates were 95.5 ± 2.5% at six months, 94.0 ± 2.9% at one year, 88.3 ± 4.2% at two years, and 75.7 ± 7.9% at five years.
Conclusions
The vast majority of eyes treated with DMEK showed consistent clinical stability, coupled with a remarkable early enhancement in visual acuity. These outcomes underscore the significance of DMEK as a safe and highly effective therapeutic approach for managing various corneal endothelial pathologies.