Original article
Endothelial Cell Density after Descemet Membrane Endothelial Keratoplasty: 1- to 2-Year Follow-up

https://doi.org/10.1016/j.ajo.2009.04.025Get rights and content

Purpose

To evaluate donor endothelial cell density (ECD) after Descemet membrane endothelial keratoplasty (DMEK).

Design

Nonrandomized, prospective clinical study.

Methods

From a larger group of patients who underwent DMEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy, complete ECD measurements were available of 26 patients with 6 and 12 months of follow-up, of whom 7 also had 24 months of follow-up.

Results

For the group with 24 months of follow-up, ECD averaged 2700 (± 260) cells/mm2 before surgery, 2200 (± 460) cells/mm2 at 6 months after surgery, 2050 (± 330) cells/mm2 at 12 months after surgery, and 1780 (± 390) cells/mm2 at 24 months after surgery. For the group with 12 months of follow-up, ECD averaged 2620 (± 210) cells/mm2 before surgery, 1850 (± 540) cells/mm2 at 6 months after surgery, and 1680 (± 550) cells/mm2 at 12 months after surgery. In both groups, the ECD decreased significantly between the preoperative and 6-month measurement (P < .05).

Conclusions

Similar to earlier endothelial keratoplasty techniques, DMEK may be associated with a decrease in donor ECD of approximately 25% in the early postoperative phase.

Section snippets

Methods

From a group of 33 consecutive patients who underwent DMEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy, complete ECD measurements were available in 26 patients (15 males and 11 females; age range, 45 to 87 years) with 6 and 12 months of follow-up; 7 of these patients also had 24 months of follow-up (Table 1). From 7 of the 33 patients, postoperative ECD measurements could not be obtained or were considered unreliable.

From donor globes less than 36 hours after death,

Results

After DMEK, all transplanted corneas showed complete clearance and remained clear throughout the follow-up (Figure 2). For the group with up to 24 months of follow-up, donor ECD averaged 2700 (± 260) cell/mm2 before surgery, 2200 (± 460) cell/mm2 at 6 months after surgery, 2050 (± 330) cells/mm2 at 12 months after surgery, and 1780 (± 390) cells/mm2 at 24 months after surgery (n = 7; Figure 3;Table 1). The mean endothelial cell loss was 19% at 6 months after surgery, 24% at 12 months after

Discussion

The current study shows that in DMEK, a postoperative ECD of approximately 1700 to 2000 cells/mm2 may be obtained at 1 to 2 years after surgery (Table 1). Compared with preoperative values, the ECD showed a 19% to 29% decrease at 6 months. Although not included in this report, the 1- and 3-month ECD measurements did not differ significantly from those at 6 months. These findings may indicate that the drop in cell density occurs during or shortly after transplantation of the donor tissue.

References (26)

  • M.O. Price et al.

    Descemet's stripping endothelial keratoplasty

    Curr Opin Ophthalmol

    (2007)
  • F.W. Price et al.

    Descemet's stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant

    J Refract Surg

    (2005)
  • M.O. Price et al.

    Randomized, prospective comparison of pre-cut vs. surgeon-dissected grafts for Descemet stripping automated endothelial keratoplasty

    Am J Ophthalmol

    (2008)
  • Cited by (86)

    • Determinants of visual quality after endothelial keratoplasty

      2016, Survey of Ophthalmology
      Citation Excerpt :

      Busin has also reported better visual outcomes with his ultrathin-DSAEK technique compared with conventional DSAEK, achieving grafts of 73 ± 14 μm.A DMEK, which aims to replace donor endothelium-Descemet membrane with no overlying stroma, has been shown to be superior to DSEK or DSAEK in terms of visual outcomes, particularly in the early postoperative period.46,48,50,75,96,101,103,104,122 Tourtas and colleagues found that central corneal thickness reduced from 652 ± 92 μm to 517 ± 45 μm after DMEK and from 698 ± 137 μm to 618 ± 66 μm after DSAEK.122

    View all citing articles on Scopus
    View full text