Midterm Results of Descemet Membrane Endothelial Keratoplasty: 4 to 7 Years Clinical Outcome.
OBJECTIVE
To evaluate the midterm outcomes of Descemet membrane endothelial keratoplasty (DMEK) up to 4-7 years postoperatively.


METHODS
Retrospective, consecutive interventional case series.


METHODS
A total of 250 consecutive eyes of 209 patients who underwent DMEK at our institute and had potentially at least 4 years of follow-up. Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD), central corneal thickness (CCT), graft survival rate, and postoperative complications.


RESULTS
At 6 months postoperatively, 73% of the eyes reached a BCVA of ≥20/25 (0.8) and 44% ≥20/20 (1.0), and remained stable up to 7 years (P = .7114). ECD dropped by 33.9% in the first 6 months, and then declined by a yearly rate of 9.0%. CCT did not show a significant change after 6 months up to 7 years (P = .8447). The cumulative graft survival rate at 4 and 7 years was 0.96 (95% confidence interval [0.93, 0.99]). Rebubbling procedures were performed in 4.4% of eyes, all within the first 6 postoperative months. Repeat transplantations were performed in 15.2% of cases to manage greater than one third graft detachment (11.6%), primary graft failure (1.6%), or secondary graft failure (2.0%), with the majority (79%) of repeat transplantations performed within the first year. After 6 months, the main complications were allograft rejection (2.4%) and secondary graft failure (2.0%).


CONCLUSIONS
The visual acuity level achieved at 6 months after DMEK may remain stable up to at least 4-7 years; ECD shows a constant, slow decrease; and complications after the first 6 months occur in <5% of cases.
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic, Rotterdam, Netherlands; Amnitrans Eye Bank, Rotterdam, Netherlands.
Lisanne
L
Ham
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic, Rotterdam, Netherlands.
Isabel
I
Dapena
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic, Rotterdam, Netherlands.
Vasilis S
VS
Liarakos
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic, Rotterdam, Netherlands.
Lamis
L
Baydoun
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic, Rotterdam, Netherlands.
Korine
K
van Dijk
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic, Rotterdam, Netherlands; Amnitrans Eye Bank, Rotterdam, Netherlands.
Abbas
A
Ilyas
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands.
Silke
S
Oellerich
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic, Rotterdam, Netherlands; Amnitrans Eye Bank, Rotterdam, Netherlands. Electronic address: research@niios.com.
Gerrit R J
GR
Melles
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003316:Corneal Diseases / Q000175:diagnosis / Q000601:surgery*; D063171:Corneal Pachymetry; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity