Effect of Surgical Indication and Preoperative Lens Status on Descemet Membrane Endothelial Keratoplasty Outcomes

Birbal RS, Baydoun L, Ham L, Miron A, van Dijk K, Dapena I, Jager MJ, Böhringer S, Oellerich S, Melles GRJ

Abstract

PURPOSE To analyze 6-month results of 1000 consecutive Descemet membrane endothelial keratoplasty (DMEK) cases, and to evaluate if outcomes are influenced by surgical indication and preoperative lens status. DESIGN Retrospective, interventional case series. METHODS A series of 1000 eyes (738 patients) underwent DMEK mainly for Fuchs endothelial corneal dystrophy (FECD; 85.3{\%}) or bullous keratopathy (BK; 10.5{\%}). Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density, postoperative complications, and retransplantations. RESULTS At 6~months after DMEK, there was no difference in BCVA outcome between FECD and BK eyes (P~= .170), or between phakic and pseudophakic FECD eyes (P~= .066) after correcting for patient age and preoperative BCVA. Endothelial cell loss at 6~months postoperatively was similar for phakic and pseudophakic FECD eyes (39{\%}; P~= .852), but higher for BK eyes than for FECD eyes (46{\%} vs 39{\%}, P~= .001). Primary and secondary graft failure occurred in 3 (0.3{\%}) and 2 eyes (0.2{\%}), respectively, and 7 eyes developed allograft rejection (0.7{\%}). Eighty-two eyes (8.2{\%}) received rebubbling for graft detachment and retransplantation was performed in 20 eyes (2.0{\%}). Rebubbling was more often required in eyes treated for BK vs FECD eyes (12.4{\%} vs 7.4{\%}, P~= .022). CONCLUSION DMEK consistently provides excellent short-term results, with similar high visual acuity levels for both FECD and BK eyes. As preoperative lens status did not influence DMEK outcomes, for phakic FECD eyes with a still relatively clear crystalline lens, lens preservation may be preferable in a selected group of younger patients, who may still benefit from their residual accommodative capacity.