For corneal endothelial pathologies, DMEK is now considered the standard of care in Germany. Photo: Aaron Bronner, OD. Click image to enlarge.
Descemet’s membrane endothelial keratoplasty (DMEK) is one of the most widely performed keratoplasty techniques today. In the United States, the number of DMEK procedures performed has doubled each year since 2011, with DMEK comprising 45% of all endothelial keratoplasty procedures in the country. In Germany, the routine procedure is now considered the standard of care for corneal endothelial pathologies, based on the results of a recent large-scale multicenter study.
The retrospective study included 3,200 DMEK patients with at least six months of follow-up in more than seven centers across Germany. Patients had either Fuchs’ endothelial corneal dystrophy (FECD) or bullous keratopathy (BK). The researchers reported that for patients without vision-limiting comorbidities (74% of analyzed eyes), the mean BCVA improved from 0.6 to 0.2 logMAR (approximately 20/80 to 20/32 Snellen) at six months and to 0.1 logMAR (20/25) at 12 months post-op.
Overall, the graft failure and rejection rates in the study were low (3% and 1.5%, respectively). The study included only experienced corneal surgeons so the number of transplanted grafts per center wasn’t associated with a different outcome, the researchers noted in their paper.
Patients with BK had worse visual outcomes than those with FECD (0.3 vs. 0.1 logMAR at 12 months, respectively). The researchers reported decreased mean endothelial cell density from 2,465 cells/mm2 to 1,587 cells/mm2 after 12 months.
The mean rebubbling rate was 0.4 per eye. A quarter of eyes received at least one rebubbling. More rebubbling was correlated with a lower endothelial cell density, worse BCVA, greater corneal thickness and higher rates of transplant failure and rejection. Notably, one rebubbling didn’t influence visual outcomes.
“Based on this large multicenter study in Germany, DMEK is now considered standard of care for treating corneal endothelial dysfunction,” the researchers concluded in their paper.
Spaniol K, Hellmich M, Borgardts K, et al. DMEK outcomes after one year—results from a large multicenter study in Germany. Acta Ophthalmol. September 30, 2022. [Epub ahead of print].