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Long-term DMEK-associated endothelial cell loss lower than in DSEK, PK
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Endothelial cell loss associated with Descemet’s membrane endothelial keratoplasty compared favorably with that of Descemet’s stripping endothelial keratoplasty and penetrating keratoplasty at 5 years, according to a study.
Additionally, endothelial cell loss did not increase significantly when a single air reinjection was used with DMEK.
Researchers retrospectively analyzed data collected from 926 DMEK procedures; 673 eyes met the inclusion criteria of at least 6 months of follow-up.
The researchers recorded endothelial cell density preoperatively and at 1, 3 and 6 months, and annually for up to 5 years. Variance analysis was used to evaluate a potential association between air reinjection and endothelial cell loss.
In cross-sectional and longitudinal analyses, median endothelial cell loss was 26% at 1 month and increased to 39% at 5 years. Earlier reports showed median 5-year endothelial cell loss rates of 53% for DSEK and 70% for PK, according to the researchers.
Rates of cell loss were similar in cases with no air reinjection or one reinjection; rates were markedly higher in eyes with two or more reinjections, the researchers found (P = .017).
Disclosure: The authors have no relevant financial disclosures.
Perspective
Back to TopMark A. Terry, MD
The authors have presented the first longitudinal study of endothelial cell loss following DMEK over a five-year period and found that a single re-bubble event did not seem to influence either the endothelial cell loss or the graft survival. Their data are preliminary good news for DMEK surgeons, but the study suffers from the same inherent problems as other longitudinal studies of PK, DSAEK and now DMEK. Endothelial counts at all time gates are only those of grafts that survived to that time point, and the median and interquartile data presented do not fully reflect the extremely wide range of cell loss that can occur with DMEK.
Although comforting, the data presented are not predictive of outcome for the individual procedure, so surgeons still need to consider surgical technique and instrumentation that prioritize endothelial safety as the primary driver of low re-bubble rates and long-term endothelial survival.
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