DMEK outcome after one year - Results from a large multicenter study in Germany.

Autor: Spaniol K; Department of Ophthalmology, University Hospital Düsseldorf, Düsseldorf, Germany., Hellmich M; Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany., Borgardts K; Department of Ophthalmology, University Hospital Düsseldorf, Düsseldorf, Germany., Girbardt C; Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany., Maier P; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany., Reinhard T; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany., Torun N; Department of Ophthalmology, Charité Universitätsmedizin - Berlin, Corporate Member of Freie Universität Berlin, Humbolt-Universität zu Berlin und Berlin Institute of Health, Berlin, Germany., Maier AK; Department of Ophthalmology, Charité Universitätsmedizin - Berlin, Corporate Member of Freie Universität Berlin, Humbolt-Universität zu Berlin und Berlin Institute of Health, Berlin, Germany., Thaler S; Department of Ophthalmology, University Hospital Tübingen, Tübingen, Germany., Bartz-Schmidt KU; Department of Ophthalmology, University Hospital Tübingen, Tübingen, Germany., Wiedemann P; Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany., Seitz B; Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany., Daas L; Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany., Schrittenlocher S; Department of Ophthalmology, University Hospital Cologne, Cologne, Germany., Cursiefen C; Department of Ophthalmology, University Hospital Cologne, Cologne, Germany., Bachmann B; Department of Ophthalmology, University Hospital Cologne, Cologne, Germany., Geerling G; Department of Ophthalmology, University Hospital Düsseldorf, Düsseldorf, Germany.
Jazyk: angličtina
Zdroj: Acta ophthalmologica [Acta Ophthalmol] 2023 Mar; Vol. 101 (2), pp. e215-e225. Date of Electronic Publication: 2022 Sep 30.
DOI: 10.1111/aos.15257
Abstrakt: Purpose: Descemet membrane endothelial keratoplasty (DMEK) accounts for >50% of all corneal transplants in Germany. So far, no data from such a large multicenter study have been published.
Methods: This retrospective study included 3200 DMEKs at seven departments performed for Fuchs endothelial corneal dystrophy (FECD) or bullous keratopathy (BK). We evaluated best corrected visual acuity (BCVA, logMAR), endothelial cell density (ECD, cells/mm 2 ), minimal corneal thickness (CT, μm), rebubbling-, primary transplant failure- and immune reaction-rate. Changes over time were evaluated by linear mixed models for repeated measures and correlation with case number by center by weighted linear regression.
Results: For patients without vision-limiting comorbidities (74% of all analysed eyes, n = 2270), mean BCVA improved from 0.6 ± 0.4 logMAR to 0.2 ± 0.2 logMAR 6 months (p < 0.001, n = 1441) and 0.1 ± 0.2 logMAR 12 months (p = 0.001, n = 1402) postoperatively. BK- had a worse BCVA compared to FECD-patients (0.3 ± 0.5 vs. 0.1 ± 0.2 logMAR [p < 0.001] at 1 year). ECD declined from 2465 ± 259 cells/mm 2 (n = 2876 preoperatively) to 1587 ± 433 cells/mm 2 after 12 months (p < 0.001, n = 1237). Mean rebubbling rate was 0.4 ± 0.7/eye. 784 eyes (25%) received at least one rebubbling. More rebubblings correlated with a lower ECD, a worse BCVA, a higher CT, and higher transplant failure and rejection rates (p < 0.001, p = 0.013 for BCVA at 12 months). A single rebubbling did not influence the BCVA (p = 0.785). Graft failure rate was 3% (n = 67), rejection rate 1.5% (n = 48).
Conclusion: Descemet membrane endothelial keratoplasty increases visual acuity with low transplant failure- and rejection-rates. FECD has a better outcome than BK. Since a quarter of all patients need a rebubbling, this should be included in the informed consent. Remarkably, one rebubbling has no influence on the outcome.
(© 2022 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)
Databáze: MEDLINE
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