37 Descemet membrane endothelial keratoplasty (DMEK): 10-year clinical outcomes and graft survival

Abstract

Purpose: To evaluate graft survival and clinical outcomes up to 10 years after Descemet membrane endothelial keratoplasty (DMEK).

Setting/venue: Retrospective cohort study conducted at the Netherlands Institute for Innovative Ocular Surgery.

Methods: 750 consecutive DMEK eyes, not including the very first 25 DMEK eyes that constitute the technique learning curve, were included. Main outcome parameters (survival, best-corrected visual acuity (BCVA), central endothelial cell density (ECD)) was evaluated up to 10-years postoperatively and postoperative complications were documented. Outcomes were analyzed for the entire study group and separately for the subgroup of the first 100 DMEK eyes.

Results: For the subgroup of 100 DMEK eyes, 82% and 89% reached a BCVA of ≥20/25 (Decimal VA ≥0.8) at 5- and 10 years postoperatively, respectively, and preoperative donor ECD decreased by 59% at 5 years and 68% at 10 years postoperatively. Graft survival probability for the first 100 DMEK eyes was 0.83 [95% Confidence Interval (CI), 0.75-0.92] and 0.79 [95% CI, 0.70 -0.88] at 5- and 10-years postoperatively, respectively. For the total study group, clinical outcome in terms of BCVA and ECD were comparable, but graft survival probability was significantly higher at 5- and 10-year postoperatively.

Conclusions: Most eyes operated in the pioneering phase of DMEK showed excellent and stable clinical outcomes with a promising graft longevity over the first decade after surgery. The increase in DMEK experience resulted in a lower graft failure rate and positively affected longer-term graft survival probability.