Ten years of Descemet membrane endothelial keratoplasty: Identifying risk factors and early failure signs.

PURPOSE: To evaluate the effect of surgical indications and complexity on long-term clinical outcomes in Descemet membrane endothelial keratoplasty (DMEK) and identify early signs of graft failure.

DESIGN

Retrospective case series of 105 patients who underwent DMEK from March 2012 to December 2014.

METHODS

Surgical results were analyzed at 1 year, 3 years, 5 years, and 10 years based on surgical indication: fuchs endothelial dystrophy (FECD) (n = 47) and bullous keratopathy (BK) (n = 58), and on the presence of anterior segment comorbidities: simple (n = 63) versus complex (n = 42) DMEK.

RESULTS

Fifty-two patients (54 eyes) were followed up for 3 years, 35 patients (42 eyes) reached the 5-year follow-up, and 20 patients (26 eyes) achieved the 10-year follow-up. Simple DMEK procedures and FECD demonstrated significantly better best corrected visual acuity (BCVA) compared to complex DMEK and BK at 1 year, 3 years, 5 years, and 10 years, respectively (P < 0.01). No statistically significant difference in endothelial cell density (ECD) decline was noted between simple and complex DMEK procedures, nor between FECD and BK (P > 0.05). Central and peripheral pachymetry were significantly higher in BK and complex surgeries at 10 years.

CONCLUSION

While DMEK represents a promising therapeutic avenue for corneal decompensation alongside anterior segment comorbidities, extended follow-up indicates a rise in central and peripheral pachymetry in comparison with simple DMEK. This increase could serve as an early indicators of corneal decompensation, potentially leading to reduced survival rates.