Warren Apel1, Nicola Glasson1, Andrew Apel2, Jessica Wilson2, Kate Hogden3
Purpose: Descemet Membrane Endothelial Kerato- plasty (DMEK) is the selective transplantation of an isolated descemet’s membrane carrying its endothe- lium. Partial or complete graft detachment is the main complication of the procedure, occurring in up to 82% of cases. Various theories for graft detach- ment have been postulated including donor age, endothelial cell density and graft preparation.
Method: This retrospective observational cohort study aimed to determine the success of DMEK in relation to donor corneal age. All patients who underwent DMEK at a solo ophthalmological prac- tice over a 5-year period were eligible. Three key measures were assessed; i) success at 3 months, deﬁned as a best corrected visual acuity (BCVA) of 6/12 or better with a clear attached graft, ii) the rebubble rate, and iii) a ﬁnal BCVA of 6/6.
Results: Data was collected on 285 grafts, in 227 eyes over a 5-year period. At 3-months, 74.04% of grafts were successful. A total of 76.3% of grafts were successful in patients aged over 40 years, com- pared with 33.33% of grafts in patients less than 40years (P = 0.0002). The rebubble rate was signiﬁ- cantly higher in patients less than 40 years [1.8 (0-39years), 1.02 (≥40 years); P = 0.0838).
Conclusion: This study suggests a strong relation- ship between increased corneal donor age and
DMEK success. We propose that the cornea has a propensity to stiffen and thicken with age which results in greater donor adherence to host tissue, decreased detachment and increased graft success. These ﬁndings have signiﬁcance for selection of donor corneal tissue when performing DMEK.