DMEK for Corneal Endothelial Disease Helps Maintain Normal Near Acuity for 5 Years

Descemet membrane endothelial keratoplasty (DMEK) can effectively treat corneal endothelial diseases with favorable visual outcomes maintained through 5 years, according to a study published in Cornea.

Records from 60 eyes of 51 patients (mean age 67, 67% women)) undergoing uneventful DMEK for Fuchs endothelial dystrophy (FED; n=53) and/or bullous keratopathy (BK; n=7) at Philipps University of Marburg in Germany were retrospectively reviewed. Corneal densitometry (CD), endothelial cell density (ECD), best-corrected visual acuity (BCVA), and central corneal thickness (CCT) were assessed through 5 years.

At 2 years, mean CD of the central cornea decreased in the anterior layer from 51.4 to 28.1 grayscale units (GSU), the central layer from 24.4 to 16.6 GSU, the posterior layer from 23.2 to 14.1 GSU, and total CD from 33.0 to 19.6 GSU (P <.001). At 5 years, the CD had increased to 32.2, 18.5, 14.6, and 21.8 GSU (P <.001), respectively.

A similar pattern was observed for the CD of the paracentral cornea which decreased at year 2 (P <.001), increasing between years 2 and 5 (P <.001).

For the midperipheral cornea at year 2, the anterior layer, central layer, and total CD remained unchanged while the posterior layer increased from 23.1 to 25.0 GSU (P =.008). Between years 2 and 5 all regions increased significantly (P <.001).

Mean ECD decreased from 2496±267 to 1063±470 cells/mm² at year 5, corresponding to a total endothelial cell loss of 57.4%. ECD and CD (at 0-2 mm) were negatively correlated (r, -0.281; P =.031).

BCVA improved from 0.57±0.31 preoperatively to 0.15±0.17 at month 3 (P ≤.001). At 6 months, BCVA increased to 0.10±0.19, remaining stable through the end of follow-up. BCVA was positively correlated with CD at all layers and zones (all P <.05), except the paracentral zone at 5 years and midperipheral zone at 24 months and 5 years.

Mean CCT decreased at 3 and 6 months (both, P <.001), but increased steadily through 5 years, reaching 557±37 μm (P <.001). CD and multiple CCT layers at several time points were correlated.

Adverse effects of peripheral tearing to the Descemet membrane due to strong adhesion were observed among 3 cases. No intraoperative graft unfolding and positioning were reported.

This study was limited by its small sample size and retrospective design.

This study shows that, although there is an overall increase in CD following DMEK for the treatment of corneal endothelial diseases, a near-to-normal visual outcome can be achieved and persist for at least 5 years.

Reference

Droutsas K, Kappos N, Giallouros E, et al. Corneal densitometry after uneventful Descemet membrane endothelial keratoplasty—5-year outcomes. Cornea. Published online November 24, 2021. doi:10.1097/ICO.0000000000002919