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Lower risk of rejection with DMEK may allow for reduced corticosteroid regimen
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MILAN — The significantly lower rejection rate of Descemet’s membrane endothelial keratoplasty compared with all other allograft techniques improves patient care and management, allowing administration of lower doses of corticosteroids, according to one surgeon.
“In our own studies we found a significant difference within a 2-year period in the rejection rate of DSEK (12%) compared to PK (18%), but an even lower rate less than 1% with DMEK,” Francis W. Price Jr., MD, said at the European Society of Cataract and Refractive Surgeons meeting.
Francis W. Price Jr.
By proportional hazard analysis, the relative risk ratio for immunological graft rejection at 2 years with DMEK turned out to be 15 times lower than Descemet’s stripping endothelial keratoplasty and 20 times lower than penetrating keratoplasty.
“This makes us aware of the tremendous benefits that DMEK has compared to other techniques,” Price said. “We should now consider it the gold standard if we look at prevention of failure.”
Hybrid techniques that leave a small rim of stroma, such as Descemet’s membrane automated endothelial keratoplasty or ultra-thin DSEK, showed to be closer to DMEK than to DSEK, but they still had a higher rejection rate of 4% at 2 years.
In his nearly 700 DMEK cases, Price had only three rejection episodes, all related to discontinuation of steroids.
DMEK, he said, is likely to require lower doses of corticosteroids than other techniques, resulting in reduced side effects, specifically the risk of ocular hypertension.
A multicenter study evaluating the safety and efficacy of a reduced steroid regimen after DMEK is currently ongoing.
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Disclosure: Price has no relevant financial disclosures.