title: Incidence and Clinical Course of Immune Reactions after Descemet Membrane Endothelial Keratoplasty: Retrospective Analysis of 1000 Consecutive Eyes.
abstract: To analyze the incidence and clinical course of graft rejection episodes after Descemet membrane endothelial keratoplasty (DMEK).
  
  
  
  Retrospective analysis of a consecutive, interventional case series.
  
  
  
  One thousand eyes that underwent DMEK from July 2011 through August 2015 at the Department of Ophthalmology, University of Cologne.
  
  
  
  All cases with follow-up of at least 1 month were included (mean follow-up, 18.5 months). Patients with a graft rejection episode were followed up for 1 additional year.
  
  
  
  Incidence of graft rejection, best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD), and need for regraft.
  
  
  
  Nine hundred five cases met the inclusion criteria. A graft rejection episode developed in 12 patients (estimated probability of rejection at 1 year, 0.9%; at 2 years, 2.3%; at 4 years, 2.3%). At time of rejection, 9 of 12 patients had stopped corticosteroids. Five patients were symptomatic and 7 did not note the rejection episode. Intensified topical corticosteroid therapy was started immediately after diagnosis of rejection. Two eyes decompensated and required a regraft, whereas the remaining 10 eyes required no regraft (BSCVA, 0.27±0.28 logarithm of the minimum angle of resolution [logMAR]; CCT, 554.1±39.1 μm at last visit before rejection vs. BSCVA, 0.21±0.15 logMAR; CCT, 540.0±15.0 μm 3 months after rejection). One year after the rejection episodes, BSCVA and CCT in these eyes remained unchanged when compared with the last visit before rejection (BSCVA, 0.15±0.11 logMAR; CCT, 533.8±26.0 μm). Significant changes were observed for ECD values (1741±274.5 cells/mm2at last visit before rejection vs. 1356±380.3 cells/mm2after 3 months [P = 0.04] and 1290±359.0 cells/mm2after 1 year [P = 0.01]).
  
  
  
  The risk for graft rejection after DMEK is low, and an even smaller minority requires a regraft. After intensified local corticosteroid therapy, most patients show stable visual acuity and CCT, although ECD decreases. The occurrence of immune reactions up to 2 years after surgery predominantly in patients not receiving corticosteroids supports the prolonged use of corticosteroids after DMEK.
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany; Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany. Electronic address: deniz.hos@uk-koeln.de.
authors.forename: Deniz
authors.initials: D
authors.lastname: Hos
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Onur
authors.initials: O
authors.lastname: Tuac
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Schaub
authors.affiliation: Singapore Eye Research Institute, Singapore, Republic of Singapore.
authors.forename: Tisha P
authors.initials: TP
authors.lastname: Stanzel
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Silvia
authors.initials: S
authors.lastname: Schrittenlocher
authors.affiliation: Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Hellmich
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Björn O
authors.initials: BO
authors.lastname: Bachmann
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany; Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Cursiefen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis; D063171:Corneal Pachymetry; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000276:immunology*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology