Visual Results and Endothelial Outcomes for DMEK as Primary Procedure for Endothelial Dysfunction or Secondary Procedure After Primary Graft Failure
Purpose
To evaluate our outcomes for DMEK in patients with endothelial dysfunction in terms of postoperative visual acuity, endothelial cell count, detachment, rejection, and rebubbling rate.
Methods
This retrospective review included 157 eyes that underwent DMEK as a primary procedure for endothelial dysfunction secondary to Fuch’s dystrophy or pseudophakic bullous keratopathy, including cases of failed DSAEK or PKP. Pre and postoperative visual acuity, endothelial cell count, detachment, rejection, and rebubbling rates were assessed during the follow-up period.
Results
Preoperative etiologies included Fuchs Dystrophy in 101 cases (64%) and Pseudophakic Bullous Keratopathy in 56 cases (36%). Average visual acuity (VA) improved from 0.9 (+/- 0.6) to 0.4 (+/- 0.3) logMar. Endothelial cell count averaged 2019 cells (+/- 930) per mm2 after 3 months. Significant detachments requiring a rebubbling procedure were found in 13 cases (8.3%). Failure of the graft occurred in 9 cases (6%) that required a new DMEK transplant within 6 weeks of the first one. No episodes of immunologically related graft rejection were found in this case series. Total follow-up ranged from 1-23 months (average of 10.8 +/- months).
Conclusion
Patients that underwent DMEK for endothelial dysfunction achieved a significant and sustained improvement on visual quality. Further studies are required to determine the significance for risk factors for detachment and failure, such as learning curve and other eye morbidities.