P-14 Descemet stripping endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: 5-year graft survival and endothelial cell loss in patients with Fuchs’ endothelial dystrophy

• Published in: BMJ open ophthalmology Vol. 7; no. Suppl 1; p. A4
• Main Authors: Fu, Lana, Hollick, Emma J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.05.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Bowman Club 2022, 25 March 2022; Corneal transplantation; Eye surgery
• ISSN: 2397-3269; 2397-3269
• DOI: 10.1136/bmjophth-2022-BCM.11

*Correspondence – Lana Fu: L.Fu@nhs.netObjectiveTo compare endothelial cell loss, graft survival, and clinical outcomes in patients with Fuchs’ endothelial dystrophy (FED) up to 5 years after Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK).Methods318 consecutive DSEK (n=189) and DMEK (n=129) grafts of 223 patients performed by 8 surgeons with standardised protocols between January 2006 and October 2021 were analysed. Group differences were compared with parametric and non-parametric tests. Kaplan-Meier analysis and Cox regression were conducted for graft survival and identify graft failure and rejection risk factors.ResultsAt 5 years, graft survival was 97% and 98% (p=0.370) in DSEK and DMEK eyes. Mean percentage endothelial cell loss was 56.6±17.6 in DSEK and 55.6±15.2 in DMEK eyes (p=0.865). Mean BSCVA was 0.12±0.13 LogMAR in DSEK and 0.00±0.17 in DMEK grafts (p<0.00001) at 5 years postop. Within 5 years, 12% of DSEK and 9% of DMEK eyes developed allograft rejection (p=0.412). Rebubbling was performed in 9.0% of DSEK and 2.3% of DMEK grafts (p=0.211). Cox regression identified rejection episode (HR 1.36; 95% CI: 2.31–80.22 (p=0.004)) as a significant contributing factor for graft failure.ConclusionsAt 5 years there was no significant difference in graft survival or endothelial cell loss between DMEK and DSEK eyes with FED. We propose that our standardised technique reduces the need for rebubbling. DMEK had superior visual acuity outcomes compared with DSEK in these patients up to 5 years after surgery.