Endothelial Survival After Descemet Membrane Endothelial Keratoplasty: Effect of Surgical Indication and Graft Adherence Status.
OBJECTIVE
This study evaluates the longevity of Descemet membrane endothelial keratoplasty (DMEK) grafts in terms of endothelial survival and endothelial failure.


OBJECTIVE
To determine endothelial survival and its association with the indication for surgery and/or partial graft detachment in DMEK.


METHODS
Retrospective cross-sectional study of data collected from August 8, 2006, until June 17, 2015, at a tertiary referral center. A total of 352 eyes were evaluated up to 8 years after DMEK for Fuchs endothelial corneal dystrophy (FECD; n = 314), bullous keratopathy (BK; n = 31), and failed previous endothelial graft (n = 7), of which 314 eyes had complete graft attachment and 38 eyes had partial graft detachment (one-third of the graft surface area or less). Endothelial cell density was measured with specular microscopy, and Kaplan-Meier survival estimates were based on eyes with endothelial failure. Endothelial survival was followed up to 8 years after DMEK.


METHODS
Endothelial cell density, endothelial failure, and endothelial survival.


RESULTS
Endothelial cell density decreased to a mean (SD) of 952 (366) and 771 (321) cells/mm2 at 7 and 8 years postoperatively, respectively. Higher endothelial cell densities were found in eyes with FECD compared with those with BK (estimated mean difference, 261 cells/mm2; 95% CI, 118-404; P = .003) and in eyes with attached grafts compared with those with partially detached grafts (estimated mean difference, 330 cells/mm2; 95% CI, 208-452; P < .001), until 8 years. In 11 eyes (3.1%) that had concomitant ocular pathology, endothelial failure occurred within 4 years after DMEK. The overall graft survival probability was 0.96 at 5 and 8 years (95% CI, 0.94-0.99). At 8 years, better survival rates were found in eyes with FECD than in those with BK (survival probability, 0.97 [95% CI, 0.95-0.99] vs 0.84 [95% CI, 0.70-0.99], respectively); until the same follow-up, survival probabilities in eyes with attached and partially detached grafts were 0.97 (95% CI, 0.95-0.99) and 0.91 (95% CI, 0.82-0.99), respectively.


CONCLUSIONS
Endothelial decay was higher in eyes with a partial graft detachment than in those with attached grafts and lower in eyes with FECD than in those with BK. Endothelial failure only occurred in eyes with concomitant ocular pathology. These results suggest that eyes with DMEK that have undergone surgery for FECD with a completely attached graft may have an excellent prognosis.
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands2Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands3Amnitrans Eye Bank, Rotterdam, the Netherlands.
Lamis
L
Baydoun
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands2Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands3Amnitrans Eye Bank, Rotterdam, the Netherlands.
Lisanne
L
Ham
Department of Ophthalmology, Centre Hospitalier National d'Ophtalmologie des XV-XX, UPMC University of Paris, Paris, France.
Vincent
V
Borderie
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands2Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands.
Isabel
I
Dapena
Amnitrans Eye Bank, Rotterdam, the Netherlands.
Jingzhen
J
Hou
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands5Department of Methodology and Statistics, Utrecht University, Utrecht, the Netherlands.
Laurence E
LE
Frank
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands.
Silke
S
Oellerich
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands2Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands3Amnitrans Eye Bank, Rotterdam, the Netherlands.
Gerrit R J
GR
Melles
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002448:Cell Adhesion; D002452:Cell Count; D002470:Cell Survival; D055954:Corneal Endothelial Cell Loss / Q000473:pathology*; D003430:Cross-Sectional Studies; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D006084:Graft Rejection / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D000267:Tissue Adhesions; D014019:Tissue Donors; D066027:Transplant Recipients; D055815:Young Adult