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J Cataract Refract Surg. 2014 Jul;40(7):1116-21. doi: 10.1016/j.jcrs.2014.04.023.

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

Author information

1
From the Price Vision Group (Feng, F.W. Price) and the Cornea Research Foundation of America (M.O. Price, Miller), Indianapolis, Indiana, USA.
2
From the Price Vision Group (Feng, F.W. Price) and the Cornea Research Foundation of America (M.O. Price, Miller), Indianapolis, Indiana, USA. Electronic address: mprice@cornea.org.

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.

PMID:
24957432
DOI:
10.1016/j.jcrs.2014.04.023
[Indexed for MEDLINE]
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