Parameters Associated With Endothelial Cell Density Variability After Descemet Membrane Endothelial Keratoplasty

Area of Science:

• Ophthalmology
• Corneal Surgery
• Cell Biology

Background:

• Descemet membrane endothelial keratoplasty (DMEK) is a surgical procedure for corneal endothelial dysfunction.
• Endothelial cell loss (ECL) is a critical factor affecting long-term graft survival after DMEK.
• Fuchs endothelial corneal dystrophy (FECD) is a common indication for DMEK.

Purpose of the Study:

• To identify parameters influencing endothelial cell loss (ECL) after Descemet membrane endothelial keratoplasty (DMEK).
• To compare endothelial cell density (ECD) decline between eyes with low versus high ECL quartiles over a 4-year follow-up.
• To determine risk factors associated with greater ECD decline post-DMEK.

Main Methods:

• Retrospective cohort study of 351 eyes undergoing DMEK for FECD.
• Patients were categorized into low (Group 1, n=51) and high (Group 2, n=42) ECL quartiles based on postoperative cell loss.
• Multinomial regression analysis was employed to identify covariates related to ECD decline.

Main Results:

• Mean overall ECL was 33% at 1 month, 36% at 6 months, and 52% at 48 months postoperatively.
• Group 1 (low ECL) showed 12% ECL at 1 month, 13% at 6 months, and 26% at 48 months.
• Group 2 (high ECL) exhibited 59% ECL at 1 month, 64% at 6 months, and 75% at 48 months.
• Factors significantly associated with greater ECD decline included partial graft detachment, cardiovascular/stroke-related donor death, postoperative complications, and severe preoperative FECD.

Conclusions:

• DMEK outcomes are influenced by graft attachment, donor health, surgical complications, and disease severity.
• Eyes with completely attached grafts and operated in early stages of FECD demonstrated the lowest postoperative ECL.
• These findings highlight the importance of graft adherence and early intervention in optimizing DMEK success.