We previously introduced various techniques of endothelial keratoplasty in the management of corneal endothelial disorders. Most recently, we described a technique for isolated transplantation of a donor Descemet membrane and its endothelium, referred to as Descemet membrane endothelial keratoplasty (DMEK).
With deep lamellar endothelial keratoplasty and Descemet stripping (automated) endothelial keratoplasty, a decrease in endothelial cell density (ECD) of up to 43% at 6 months has been attributed to donor tissue manipulation during surgery. We previously reported that the ECD after DMEK was at least similar to that after deep lamellar endothelial keratoplasty and Descemet stripping (automated) endothelial keratoplasty, possibly because DMEK can be performed in a entirely no-touch fashion, which may reduce the risk of endothelial cell damage. In the current study, we report on the midterm ECD after DMEK as an indicator for long-term Descemet graft survival.
From a larger group of 71 consecutive patients who underwent DMEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy, complete ECD measurements were available in 58 patients (26 men, 32 women; age range, 41 to 87 years) with 6 and 12 months of follow-up; 17 of these patients also had 24 months follow-up, and 6 patients had 36 months follow-up.
For the group with 36 months follow-up, ECD averaged 2620 (± 180) cells/mm 2 before surgery, 2090 (± 390) cells/mm 2 at 6 months, 1970 (± 270) cells/mm 2 at 12 months, 1730 (± 400) cells/mm 2 at 24 months, and 1520 (± 450) cells/mm 2 at 36 months ( Figure 1 , Top). Compared with preoperative values, ECD decreased by 20% at 6 months, by 25% at 12 months, by 34% at 24 months, and by 42% at 36 months ( Figure 1 , Bottom).