Long-term follow-up of bilateral DMEK shows sustained outcomes, few complications
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Five-year follow-up of patients who underwent Descemet’s membrane endothelial keratoplasty for Fuchs’ dystrophy showed “excellent” outcomes, sustained in the long term in both eyes, according to a study.
“A bilateral postoperative complication is relatively rare up to 5 years after DMEK, and it appears safe to perform surgery in the second eye even early after the first eye,” Lamis Baydoun, MD, said at the virtual European Society of Cataract and Refractive Surgeons meeting.
Baydoun said that lessons learned from intraoperative complications in the first eye may help the surgeon prepare for the second eye surgery.
Clinical outcomes after 5 years were assessed in a group of 250 eyes of 125 patients. Time between first and second eye surgery varied from 2 months to 60 months, with a median of 11 months.
“Quick visual rehabilitation occurred in both eyes and remained stable, with similar outcomes at 6 months and 5 years. Endothelial cell density decreased by 36% in the first eye and 37% in the second eye at 6 months and by 54% and 53%, respectively, at 5 years,” Baydoun said.
Intraoperatively, there were 21 difficult descemetorhexes or double Descemet’s layer, 17 unilateral and only two bilateral, and six unilateral upside-down grafts that needed reorientation. Postoperatively, there were 40 partial graft detachments, which were bilateral in only six patients. Only four required rebubbling. Allograft rejection occurred in only six patients, of which one was bilateral. Of 17 graft failures, five unilateral and two bilateral were due to technical failure, and secondary failures occurred in one bilateral and six unilateral cases. No patient had bilateral or unilateral primary failure.
“When a patient receives DMEK, we have 1 month that is decisive for graft detachment, and refraction stabilizes by 3 months. So, after 3 months we usually operate on the second eye,” Baydoun said during the paper discussion. “If we are dealing with young patients and see that the outcomes are advancing quite nicely, we may do the second even after 2 months.”
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Baydoun L, et al. 5 year clinical outcomes of DMEK in both eyes of patients with Fuchs' endothelial corneal dystrophy. Presented at: European Society of Cataract and Refractive Surgeons meeting; Oct. 2-4, 2020 (virtual meeting).
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