Most Endothelial Cell Loss Following DMEK Occurs in First Postoperative Year

Surgeons can expect to see most endothelial cell loss in the year following DMEK, with a decline in loss thereafter.

Maximum endothelial cell loss (ECL) following Descemet membrane endothelial keratoplasty (DMEK) happens during the first year after the procedure, and then becomes more gradual in the following years, according to findings presented at the American Academy of Ophthalmology (AAO) 2022 annual meeting, held in Chicago from September 30 to October 3.

Researchers evaluated the periodical ECL in DMEK in a large series of cases that spanned 5 years, and conducted a retrospective review of electronic medical records (EMR) of 1000 consecutive DMEK procedures performed between 2016 and 2021 at a single tertiary center in India. 

All of the surgeries were performed by a single surgeon using the same technique with the same injector system. Mean endothelial cell densities (ECDs) and postoperative ECL were analyzed after 3 and 6 months, and then annually for 5 years. Data from 969 eyes were available from EMR for analysis. 

By reviewing the data, researchers identified: 

  • Mean donor ECD was 2824±169/mm² 
  • Postoperative ECD was 2178±321 (n=958) at 3 months, 1782±373 (n=674) at 1 year and 1376±439/mm² (n=119) at 5 years 
  • After 3 months, mean ECL was 23.1% (n=958) 
  • After 6 months, mean ECL was 30.6% (n=841) 
  • After 1 year, mean ECL was 36.9% (n=674)
  • After 2 years, mean ECL was 40.8% (n=504)
  • After 3 years, mean ECL was 43.9% (n=382)
  • After 4 years, mean ECL was 47.4% (n=207)
  • After 5 years, mean ECL was 51.3% (n=119]
  • Secondary graft failure occurred in 46 eyes (4.8%) in 5 years

As demonstrated in the data analysis, ECL is the most significant in the first year post DMEK, and becomes more gradual each year after. 

Disclosure: One study author declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Basak SK, Basak S. Periodic endothelial cell loss in DMEK in 1000 consecutive cases: a 5-year study. Poster presented at: The American Academy of Ophthalmology (AAO) 2022 annual meeting; September 30-October 3; Chicago. PO041.