Air reinjection and endothelial cell density in Descemet membrane endothelial keratoplasty: five-year follow-up.

Abstract

PURPOSE:

To evaluate 5-year endothelial cell loss after Descemet membrane endothelial keratoplasty (DMEK), compare it with reported rates for Descemet-stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty (PKP), and investigate potential association between cell loss and air reinjection.

SETTING:

Price Vision Group, Indianapolis, Indiana, USA.

DESIGN:

Retrospective comparative case series.

METHODS:

Consecutive DMEK procedures performed between March 2008 and April 2013 were reviewed. The inclusion criterion was at least 6 months of follow-up. Endothelial cell density was recorded preoperatively and 1, 3, and 6 months and annually through 5 years postoperatively. Potential association between air reinjection and endothelial cell loss was evaluated by repeated measures analysis of variance.

RESULTS:

Of the 926 procedures performed, 673 eyes met the inclusion criterion. Indications for DMEK included Fuchs dystrophy (n = 595), pseudophakic corneal edema (n = 30), failed endothelial keratoplasty (n = 39), and failed PKP (n = 9). The median endothelial cell loss was 26% at 1 month, increasing to 39% at 5 years in cross-sectional and longitudinal analyses. Cell loss was similar in eyes with no (n = 471) or 1 (n = 155) air reinjection and significantly higher in eyes with 2 or more air reinjections (n = 47, P=.017).

CONCLUSIONS:

The median 5-year cell loss of 39% with DMEK compared favorably with prior reports of DSEK (53%) and PKP (70%) performed for similar indications. Similar to DSEK, most DMEK cell loss was associated with the surgical procedure itself; subsequent cell loss occurred at a slower rate than after PKP. Cell loss was not significantly increased in eyes with a single air reinjection.

FINANCIAL DISCLOSURE:

No author has a financial or proprietary interest in any material or method mentioned.

• Authors: Matthew T Feng, Marianne O Price, Jalee M Miller, Francis W Price Jr
• Journal: Journal of cataract and refractive surgery (J Cataract Refract Surg) Vol. 40 Issue 7 Pg. 1116-21 (Jul 2014) ISSN: 1873-4502 [Electronic] United States
• PMID: 24957432 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Air
• Cell Count
• Cell Survival
• Corneal Diseases (surgery)
• Corneal Endothelial Cell Loss (diagnosis)
• Cross-Sectional Studies
• Descemet Stripping Endothelial Keratoplasty (methods)
• Endothelium, Corneal (pathology)
• Female
• Follow-Up Studies
• Humans
• Injections, Intraocular
• Keratoplasty, Penetrating (methods)
• Male
• Middle Aged
• Retrospective Studies
• Young Adult