Endothelial keratoplasty: indications and outcomes in a tertiary care center in Lebanon

This study aims to assess the indications and outcomes of Descemet membrane endothelial keratoplasty (DMEK) surgeries in Lebanon, where tissues are imported. Focusing on visual acuity (VA) and central corneal thickness (CCT).

This retrospective chart review analyzed 86 DMEK surgeries performed on 78 patients between 2016 and 2023, examining CCT and VA measured preoperatively and up to one-year post-DMEK. Variables of interest included the rate of rebubbling, intraocular pressure (IOP), tissue preparation methods (preloaded, surgeon-prepared, or pre-stripped/precut tissue), donor age, donor endothelial cell count, time from death to preservation, time from preservation to surgery, and time from death to transplant. The goal was to explore the relationships between these variables and the clinical outcomes.

The most common indication for DMEK was pseudophakic or aphakic bullous keratopathy (PBK), followed by graft failure and Fuchs' endothelial corneal dystrophy (FECD). Significant improvements in VA and CCT were observed postoperatively (p < 0.001 and p ≤ 0.015 respectively). The mean IOP was 16.8 mmHg at baseline and 17.2 mmHg at 1 year post-operatively. The mean LogMAR score was 1.46 ± 0.16 at baseline, improving to 0.87 ± 0.21 at the 1-year follow-up. The rebubbling rate was 28.7%. Patients who required rebubbling had significantly higher central corneal thickness (CCT) during the first month (p = 0.027), but this difference was not observed over the course of the entire year. However, a notable incidence of postoperative new onset elevation in IOP was documented, affecting approximately 36.5% of patients.

Despite challenges posed by limited resources and economic constraints in Lebanon, DMEK surgery has shown promising outcomes in improving VA and CCT. Vigilant monitoring and management of postoperative complications, particularly elevated IOP, is essential. Addressing systemic barriers to healthcare access and enhancing corneal transplantation infrastructure are crucial for ensuring equitable delivery of advanced ophthalmic care in resource-limited settings.