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Development and Clinical Validation of the DMEK Risk and Outcome Prediction (DROP) Score: A Dynamic Temporal Machine

Feyza Dicle Işık1, Emine Esra Karaca1, Kasim Oztoprak2

  • 1Department of Ophthalmology, Ankara Bilkent City Hospital, University of Health Sciences, 06800 Ankara, Turkey.

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|January 28, 2026
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Summary
This summary is machine-generated.

The new DMEK Risk and Outcome Prediction (DROP) Score offers personalized risk assessment for Descemet membrane endothelial keratoplasty (DMEK) surgery. Diabetes and hypertension are key factors influencing patient outcomes.

Keywords:
DROP scoreDescemet Membrane Endothelial Keratoplasty (DMEK)benchmarkingcorneal endotheliummachine learningrisk stratificationtemporal dynamics

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Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Medical Informatics

Background:

  • Descemet membrane endothelial keratoplasty (DMEK) requires accurate risk stratification for optimal patient outcomes.
  • Existing models may not fully integrate diverse predictive factors.
  • A comprehensive benchmarking model is needed for individualized DMEK risk assessment.

Purpose of the Study:

  • To develop and validate the DMEK Risk and Outcome Prediction (DROP) Score.
  • To integrate patient, donor, surgical, and center-specific parameters into a single predictive model.
  • To provide a tool for individualized risk assessment following DMEK.

Main Methods:

  • The DROP Score was developed using four subscores: Patient Risk Profile (PRP), Donor Tissue Quality (DTQ), Surgical Complexity Index (SCI), and Center Performance Factor (CPF).
  • Weights were literature-derived and validated via sensitivity analysis.
  • Clinical validation involved 76 DMEK eyes and 89 controls, utilizing machine learning (EfficientNetV2B3, Random Forest) and IVCM imaging.

Main Results:

  • The mean DROP Score was 39.35 ± 7.61, with 92.1% moderate and 7.9% high-risk cases.
  • High-risk patients exhibited significantly worse 12-month Best Corrected Visual Acuity (BCVA) (0.50 vs. 0.31 logMAR).
  • Diabetes mellitus (OR: 4.34) and hypertension (OR: 2.65) were identified as dominant prognostic factors.

Conclusions:

  • The DROP Score offers transparent, individualized risk assessment for DMEK.
  • Diabetes and hypertension are critical systemic factors impacting DMEK outcomes.
  • Further prospective data collection is required for complete four-domain validation of the DROP Score.