Elderly Descemet’s membrane endothelial keratoplasty (DMEK) graft recipients may be more likely to experience postoperative graft failure, in addition to shorter graft survival rates, regardless of a low incidence of early complications after the procedure, new research suggests.

The study, published in Current Eye Research, included a record review of patients who were approximately 76 years old and collectively underwent 164 DMEK surgeries between 2016 and 2018. Over a two-year follow up, investigators compared complications, graft survival and VA gains between 21 subjects aged 70 or younger (young recipient group, 25th percentile), and 27 individuals aged 85 and older (older recipient group, 75th percentile).

Compared to older individuals, younger recipients had a lower rate of pre-operative glaucoma (about 14% vs. 52%) and pseudophakic bullous keratopathy (roughly 10% vs. 59%), but a higher rate of Fuchs endothelial dystrophy (57% vs. 15%,) and combined cataract extraction at the time of DMEK surgery (52% vs. 7%).

Researchers noted complications, such as primary graft failure, pupillary block, cystoid macular edema or infectious keratitis, were independent of graft recipient age.

Other key study findings included:

  • Descemet’s membrane detachment requiring re-bubbling was more common in younger individuals compared to the older recipients (about 43% vs. 15%).
  • VA gains between the groups remained comparable up to one-year, but at two years, subjects in the older patient group showed significant decline (0.14 vs. 0.74).
  • Individuals older than 85 had a considerably higher graft failure rate over the 24 months (about 41% vs. 5%) and shorter graft survival time.
  • After adjusting for potential confounders such as Fuchs’ endothelial dystrophy, pseudophakic bullous keratopathy and glaucoma, patients older than 85 remained at higher risk for graft failure (hazard ratio: 17.278).

Achiron A, Nahum Y, Tiosano A, et al. Descemet membrane endothelial keratoplasty outcomes between young and old graft recipients. Curr Eye Res. April 11, 2021. [Epub ahead of print].