Incidence of early allograft rejection after Descemet membrane endothelial keratoplasty

Cornea. 2011 Dec;30(12):1341-5. doi: 10.1097/ICO.0b013e31820d8540.


Purpose: To report the incidence of early allograft rejection after Descemet membrane endothelial keratoplasty (DMEK), that is, transplantation of isolated Descemet membrane with its endothelium.

Methods: The first series of 120 eyes of 105 patients operated on for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy, with an average 2 years of follow-up after 9.0- to 10.0-mm-diameter DMEK, enrolled in our study.

Results: During the entire study period, only 1 of the eyes showed any signs of a cellular immune response to the Descemet graft. A 76-year-old patient presented with discomfort, reduced visual acuity to counting fingers, corneal decompensation, and a Khodadoust line in the central cornea 4 months after (decentered) DMEK. Intensified topical corticoid therapy resulted in a complete visual recovery to 20/25 (0.8) within weeks.

Conclusions: A "classic" allograft rejection (with an appearance similar to that after penetrating keratoplasty) can occur after DMEK. However, compared with the earlier (endothelial) keratoplasty procedures, DMEK may be associated with a lower rejection rate of ≤ 1%, despite transplant diameters of ± 9.5 mm. The apparent immune tolerance in DMEK may result from either less "upregulation" or more "downregulation" of the immune system.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Descemet Stripping Endothelial Keratoplasty*
  • Female
  • Follow-Up Studies
  • Graft Rejection / epidemiology*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Prospective Studies
  • Transplantation, Homologous