title: Air reinjection and endothelial cell density in Descemet membrane endothelial keratoplasty: five-year follow-up.
abstract: OBJECTIVE
  To evaluate 5-year endothelial cell loss after Descemet membrane endothelial keratoplasty (DMEK), compare it with reported rates for Descemet-stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty (PKP), and investigate potential association between cell loss and air reinjection.
  
  
  METHODS
  Price Vision Group, Indianapolis, Indiana, USA.
  
  
  METHODS
  Retrospective comparative case series.
  
  
  METHODS
  Consecutive DMEK procedures performed between March 2008 and April 2013 were reviewed. The inclusion criterion was at least 6 months of follow-up. Endothelial cell density was recorded preoperatively and 1, 3, and 6 months and annually through 5 years postoperatively. Potential association between air reinjection and endothelial cell loss was evaluated by repeated measures analysis of variance.
  
  
  RESULTS
  Of the 926 procedures performed, 673 eyes met the inclusion criterion. Indications for DMEK included Fuchs dystrophy (n = 595), pseudophakic corneal edema (n = 30), failed endothelial keratoplasty (n = 39), and failed PKP (n = 9). The median endothelial cell loss was 26% at 1 month, increasing to 39% at 5 years in cross-sectional and longitudinal analyses. Cell loss was similar in eyes with no (n = 471) or 1 (n = 155) air reinjection and significantly higher in eyes with 2 or more air reinjections (n = 47, P=.017).
  
  
  CONCLUSIONS
  The median 5-year cell loss of 39% with DMEK compared favorably with prior reports of DSEK (53%) and PKP (70%) performed for similar indications. Similar to DSEK, most DMEK cell loss was associated with the surgical procedure itself; subsequent cell loss occurred at a slower rate than after PKP. Cell loss was not significantly increased in eyes with a single air reinjection.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors: From the Price Vision Group (Feng, F.W. Price) and the Cornea Research Foundation of America (M.O. Price, Miller), Indianapolis, Indiana, USA.
authors: Matthew T
authors: MT
authors: Feng
authors: From the Price Vision Group (Feng, F.W. Price) and the Cornea Research Foundation of America (M.O. Price, Miller), Indianapolis, Indiana, USA. Electronic address: mprice@cornea.org.
authors: Marianne O
authors: MO
authors: Price
authors: From the Price Vision Group (Feng, F.W. Price) and the Cornea Research Foundation of America (M.O. Price, Miller), Indianapolis, Indiana, USA.
authors: Jalee M
authors: JM
authors: Miller
authors: From the Price Vision Group (Feng, F.W. Price) and the Cornea Research Foundation of America (M.O. Price, Miller), Indianapolis, Indiana, USA.
authors: Francis W
authors: FW
authors: Price
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D002452:Cell Count; D002470:Cell Survival; D003316:Corneal Diseases / Q000601:surgery; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D056965:Injections, Intraocular; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult