Air reinjection and endothelial cell density in Descemet membrane endothelial keratoplasty: five-year follow-up

J Cataract Refract Surg. 2014 Jul;40(7):1116-21. doi: 10.1016/j.jcrs.2014.04.023.


Purpose: To evaluate 5-year endothelial cell loss after Descemet membrane endothelial keratoplasty (DMEK), compare it with reported rates for Descemet-stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty (PKP), and investigate potential association between cell loss and air reinjection.

Setting: Price Vision Group, Indianapolis, Indiana, USA.

Design: Retrospective comparative case series.

Methods: Consecutive DMEK procedures performed between March 2008 and April 2013 were reviewed. The inclusion criterion was at least 6 months of follow-up. Endothelial cell density was recorded preoperatively and 1, 3, and 6 months and annually through 5 years postoperatively. Potential association between air reinjection and endothelial cell loss was evaluated by repeated measures analysis of variance.

Results: Of the 926 procedures performed, 673 eyes met the inclusion criterion. Indications for DMEK included Fuchs dystrophy (n = 595), pseudophakic corneal edema (n = 30), failed endothelial keratoplasty (n = 39), and failed PKP (n = 9). The median endothelial cell loss was 26% at 1 month, increasing to 39% at 5 years in cross-sectional and longitudinal analyses. Cell loss was similar in eyes with no (n = 471) or 1 (n = 155) air reinjection and significantly higher in eyes with 2 or more air reinjections (n = 47, P=.017).

Conclusions: The median 5-year cell loss of 39% with DMEK compared favorably with prior reports of DSEK (53%) and PKP (70%) performed for similar indications. Similar to DSEK, most DMEK cell loss was associated with the surgical procedure itself; subsequent cell loss occurred at a slower rate than after PKP. Cell loss was not significantly increased in eyes with a single air reinjection.

Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Air*
  • Cell Count
  • Cell Survival
  • Corneal Diseases / surgery
  • Corneal Endothelial Cell Loss / diagnosis*
  • Cross-Sectional Studies
  • Descemet Stripping Endothelial Keratoplasty / methods*
  • Endothelium, Corneal / pathology*
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Intraocular
  • Keratoplasty, Penetrating / methods*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Young Adult