• Real-World Outcomes of DMEK in the Netherlands

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD

    Journal Highlights

    American Journal of Ophthalmology, December 2020

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    Dunker et al. looked at practice patterns, graft survival, and other outcomes of Descemet membrane endothelial keratoplasty (DMEK). Their findings support the effectiveness of DMEK for restoring vision in patients with Fuchs endothelial dystrophy (FED). Graft survival improved with surgeon experience, and the degree of endothe­lial cell loss was acceptable.

    For this prospective registry study, the authors gathered data on 752 DMEKs performed from October 2011 through May 2018 that were registered in the Netherlands Organ Transplant Registry. The surgeries were performed at 10 corneal clinics in the Netherlands. The leading indication for DMEK was FED (90% of cases), followed by graft failure (5%) and pseudophakic bullous keratopathy (3%). The main outcome measure was graft survival. Secondary outcomes included best spectacle-corrected visual acuity (BSCVA), endo­thelial cell density, hyperopic shift, and rates of rebubbling.

    According to the analysis, the pro-portion of DMEKs increased significantly over time (p < .001), with the greatest increase occurring between 2015 and 2016. In contrast, the frequen­cy of Descemet stripping automated endothelial keratoplasty and penetrat­ing keratoplasty decreased after 2015. Among the 468 DMEK procedures an­alyzed for graft survival (after exclud­ing fellow eyes, non-FED indications, and cases with missing data), the graft survival rate was 87% at three months, 85% at six months and one year, and 78% at two years. The rate was signifi­cantly better for surgeries performed after 2015 (p < .001). Graft rejection occurred in two patients within six months and was reversible in both.

    At three months, the mean hyper­opic shift was +0.36 D; endothelial cell loss was 33% at this point and stabilized thereafter. BSCVA improved markedly from pretreatment through at least two years post-DMEK. By 12 months following DMEK, Snellen BSCVA ≥20/25 was achieved in 67% and ≥20/20 in 28%. The most common complication was rebubbling, which occurred in 19%.

    Although studies have shown that immunologic rejection is less common with DMEK than with other kerato­plasty techniques, the authors noted that lengthier follow-up is needed to determine long-term outcomes.

    The original article can be found here.