Long-Term Results after DMEK (Descemet’s Membrane Endothelial Keratoplasty)

Purpose: To evaluate the long-term clinical outcomes and rate of complication after Descemet’s membrane endothelial keratoplasty (DMEK) Design: a cross-sectional, case series study Methods: 142 patients who underwent DMEK in the University Eye Clinic in Marburg, Germany between 2010 and 2014 were included (230 eyes). We evaluated the best corrected visual acuity (BCVA), refraction, central corneal thickness (CCT), corneal volume (CV) and endothelial cells density (ECD) and compared them to the preoperative values. The graft survival and rate of post-operative complications were also evaluated. Results: Mean follow-up time was 47 ± 13.3 months. The BCVA improved from 0.60 ± 0.32 logMAR preoperatively to 0.10 ± 0.22 logMAR in patients with no other ocular comorbidities (201 eyes). 71.1% of the patients with no ocular comorbidities had a BCVA of 0.11 logMAR or better (≥ 0.8 decimal), whereas 49.2% of them had a full BCVA of 0.00 logMAR or better. The CCT decreased from 675 ± 112µm preoperatively to 547 ± 52 µm 4-7 years after DMEK and the CV decreased from 65.2 ± 8.4 mm2 preoperatively to 61.9 ± 5.4 mm2. The endothelial cells loss was 1392 ± 455 cells/mm², which corresponds to a total loss of 54.7% of the graft cells on average. The graft survival rate was 92% with an average survival time of 76.6 ± 1.3 months. Conclusion: DMEK provides high visual outcomes that may remain stable 4-7 years after the operation. DMEK has a high graft survival rate and a relatively low rate of postoperative complications. This renders DMEK a first-line treatment of endothelial cells diseases nowadays.