Clinical Outcomes Of Descemet Membrane Endothelial Keratoplasty (Dmek): A 7-Year Retrospective Study In A Portuguese Tertiary Hospital

To report real-world clinical outcomes in all the consecutive Descemet Membrane Endothelial Keratoplasty (DMEK) procedures performed in a tertiary hospital centre.

The study was conducted at the Ophthalmology Department of Centro Hospitalar Universitário de São João, an academic hospital in Porto, Portugal. Four experienced corneal surgeons performed the DMEK procedures. Since 2011, the institution has consistently performed a high volume of corneal transplants (exceeding 150 annually). A notable increase in the utilization of endothelial keratoplasty techniques has been observed since 2016

Retrospective, single-center, observational cohort revision of DMEK procedures performed between August 2016 and December 2023. Patients with a minimum follow-up of one-year were included. Clinical and demographic data were extracted from medical records. Primary outcomes measures included central endothelial cell density (ECD) of the donor and recipient at various post-operative times, and best corrected visual acuity (BCVA) in logMAR scale before and one year after transplantation. Postoperative complications (rebubbling) and graft failure (defined as the loss of graft function necessitating repeat keratoplasty) were considered as secondary outcomes.

152 DMEK procedures were performed on 115 patients (62.6% female). The mean age was 68.47±12.11 years. Main indications for surgery were Fuchs' dystrophy (55.9%) and pseudophakic bullous keratopathy (23.7%). Donor corneas had a mean ECD of 2590±413 cells/mm² and a mean age of 62.58±12.11 years.
At 1 year follow-up, mean BCVA improved from 0.89 to 0.26 logMAR (p<0.001). ECD decreased by 38.3% at up 6 months(1627±544cells/mm2) and 45.1% at up 12 months (1479±508cells/mm2), stabilizing to 66% loss by 4 years (862.7±389cells/mm²). Rebubbling was required in 16 eyes (11%) and was associated with surgery type (combined or isolated). Graft failure occurred in 26 eyes (17%), with 14 requiring repeat DMEK. Graft survival at 4 years was 80%

DMEK demonstrated excellent clinical outcomes, with a significant improvement in BCVA, prolonged graft survival and low complication rates. These findings reinforce DMEK as a reliable treatment for corneal endothelial diseases.