Factors Affecting Graft Survival After Descemet Membrane Endothelial Keratoplasty In Eyes With Severe Corneal Edema

To evaluate the risk factors for endothelial graft survival after Descemet membrane endothelial keratoplasty (DMEK) in eyes with severe corneal edema.

Retrospective cohort study

This retrospective study included 112 eyes from 112 patients who underwent DMEK surgery for corneal decompensation since January 2014, with at least one year of follow-up and available surgical videos. Two experienced corneal surgeons performed DMEK surgeries. The demographic features, ocular co-morbidities, indications for DMEK, central corneal thickness (CCT), post-harvest graft waiting duration in cold storage medium, endothelial peeling time, graft unfolding duration, donor endothelial cell density, presence of concomitant phacoemulsification surgery, presence of preoperative and postoperative use of glaucoma medication and glaucoma surgery were recorded.

The mean CCT was 874.5 mm (692-1365 mm)(p=0.637).Graft rejection was present in 24% of the eyes.The mean rejection time was 14.8±13 months.The graft waiting duration in cold storage medium was statistically insignificant between eyes with and without graft rejection, whereas endothelial peeling time and graft unfolding duration from the injection were statistically significantly longer in the graft rejection group(p= 0.082, 0.039, 0.034, respectively).In univariate logistic regression analysis, both endothelial peeling time and graft unfolding duration were significant (OR 1.098 CI 95%; p=0.044 and OR 1.106 CI 95%; p=0.029, respectively); graft unfolding duration remained significant in the multivariate analysis (OR 1.105 CI 95%; p=0.031). 

While CCT had no effect on graft survival in eyes with severe corneal edema; the endothelial peeling time and graft placement duration from the injection were found as the two parameters affecting graft success and survival.