Risk factors for endothelial cell loss after Descemet membrane endothelial keratoplasty (DMEK)

Takahiko Hayashi,Mario Matthaei,Sebastian Siebelmann,Viet Nhat Hung Le,Silvia Schrittenlocher,Claus Cursiefen,Björn Bachmann,Jeremy Franklin

doi:10.1038/s41598-020-68023-0

Abstract

This study aimed to identify the risk factors for endothelial cell density (ECD) loss after Descemet membrane endothelial keratoplasty (DMEK) and analyse whether donor tissues from cold versus organ culture differ in terms of ECD loss after DMEK. Consecutive DMEK cases from a prospective database for Fuchs’ endothelial corneal dystrophy were retrospectively analysed between 2011 and 2016 at the University of Cologne, and the possible risk factors for ECD loss, including patient-related factors, type of tamponade (air or 20% sulphur hexafluoride gas), type of surgery (triple DMEK or DMEK alone), re-bubbling, immune rejection, and donor-related factors were determined. Eight hundred and forty-one eyes were selected. There was no significant difference in the best-corrected visual acuity (logarithm of the minimal angle of resolution) and corneal thickness (P = 0.540 and P = 0.667) between groups. Immune reactions were more common in cold cultures (P = 0.019), but ECD loss (1 year after DMEK) was greater in organ cultures (38.3 ± 0.8%) than in cold cultures (34.7 ± 1.4%) (P = 0.022). Only re-bubbling was significantly associated with ECD loss (P < 0.001). Re-bubbling was found to be a key factor for ECD loss at 1 year after DMEK.

Highlights

This study aimed to identify the risk factors for endothelial cell density (ECD) loss after Descemet membrane endothelial keratoplasty (DMEK) and analyse whether donor tissues from cold versus organ culture differ in terms of ECD loss after DMEK
Descemet membrane endothelial keratoplasty (DMEK) is a widely applied technique for performing keratoplasty and restoring vision in patients with endothelial diseases, such as Fuchs’ endothelial corneal dystrophy (FECD) or bullous k eratopathy[1,2,3,4,5]. As this technique replaces only the endothelial layer that is attached to the Descemet membrane (DM), surgeons can achieve rapid improvements in visual acuity, better final visual outcomes, and less immunological reactions, compared to other techniques[6,7,8,9], such as Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty (PKP)
Many researchers have indicated certain factors associated with ECD loss in both DMEK and PKP or in DSAEK, such as graft d iameter[13,14], surgical indication, type of filling gas[15], rebubbling, or culture medium[16,17,18], there has been no consensus on the most important factor associated with the final ECD outcome

Summary

Introduction

This study aimed to identify the risk factors for endothelial cell density (ECD) loss after Descemet membrane endothelial keratoplasty (DMEK) and analyse whether donor tissues from cold versus organ culture differ in terms of ECD loss after DMEK. Descemet membrane endothelial keratoplasty (DMEK) is a widely applied technique for performing keratoplasty and restoring vision in patients with endothelial diseases, such as Fuchs’ endothelial corneal dystrophy (FECD) or bullous k eratopathy[1,2,3,4,5] As this technique replaces only the endothelial layer that is attached to the Descemet membrane (DM), surgeons can achieve rapid improvements in visual acuity, better final visual outcomes, and less immunological reactions, compared to other techniques[6,7,8,9], such as Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty (PKP). To the best of our knowledge, this is the first study to evaluate the factors associated with ECD loss at 1 year after DMEK in a large sample

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