Five-Year Endothelial Cell Density Outcomes After DMEK Using Peripherally Versus Centrally Trephinated Donor Tissue

Area of Science:

• Ophthalmology
• Corneal Surgery
• Endothelial Keratoplasty

Background:

• Corneal endothelial dysfunction necessitates keratoplasty for vision restoration.
• Descemet membrane endothelial keratoplasty (DMEK) is a common endothelial keratoplasty technique.
• Donor tissue preparation methods may influence graft outcomes.

Purpose of the Study:

• To compare 5-year endothelial cell density (ECD) outcomes after DMEK using peripherally trephinated donor tissue (DMEK-pD) versus centrally trephinated donor tissue (DMEK-cD).
• To evaluate visual acuity, complications, and graft failure rates between the two DMEK preparation techniques.

Main Methods:

• Retrospective comparative study of 428 eyes undergoing DMEK-pD (n=205) or DMEK-cD (n=223).
• Standardized no-touch technique used, with surgeon-prepared grafts.
• ECD measured at 6 months and annually up to 5 years; visual acuity, complications, and secondary graft failure (SGF) recorded.

Main Results:

• Mean ECD was significantly higher in the DMEK-pD group at all postoperative time points up to 5 years (P < 0.001).
• Visual acuity improvement was comparable between groups (P = 0.15).
• DMEK-pD showed better long-term ECD preservation, especially in Fuchs endothelial corneal dystrophy; SGF was more frequent in DMEK-cD (10.8% vs 5.9%, P=0.13).

Conclusions:

• DMEK with peripheral donor tissue trephination offers sustained long-term ECD advantages over central trephination.
• This technique does not compromise visual outcomes or safety.
• A simple modification in donor preparation may enhance graft longevity in DMEK.