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Impact of corneal donor lens status on two-year course and outcome of Descemet membrane endothelial keratoplasty (DMEK)

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Abstract

Purpose

Our purpose was to investigate the impact of lens status of corneal donors on the two-year course and clinical outcome of Descemet membrane endothelial keratoplasty (DMEK).

Methods

In 181 DMEK surgeries, 136 phakic and 45 pseudophakic donor corneas were grafted. In this retrospective audit we compared the lens status of corneal donors regarding the outcome measures best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD) at 1, 3, 6, 12, and 24 months, as well as intra- and postoperative complication rates and graft detachment rates requiring re-bubbling.

Results

Comparing the use of phakic and pseudophakic donor tissue in DMEK surgery, BSCVA results revealed no significant differences during the two-year course (p ≥ 0.087). CCT showed significantly lower values at 1 month (553.8 ± 56 vs. 625.2 ± 119 μm; p < 0.001) and 6 months follow-up (530.6 ± 49.9 vs. 557.3 ± 47 μm; p = 0.026) for phakic donor tissue recipients, but were comparable later (p ≥ 0.173). ECD values were statistically higher 6 (1915 ± 390 vs. 1565 ± 420 cells/mm2; p < 0.001) and 24 months postoperatively (1772 ± 384 vs. 1375 ± 377 cells/mm2; p = 0.030) in phakic donor tissue recipients. Mixed regression analyses demonstrated a significant association between ECD results and donor lens status (p = 0.029) and donor ECD (p = 0.028), but donor age did not show significant influence (p = 0.241).

Conclusion

ECD is higher in phakic corneal donors and appears to remain at a higher level during the course resulting in initially faster reduction of corneal edema compared to pseudophakic DMEK grafts. Nevertheless, pseudophakic transplants with high ECD seem to produce comparable functional results in recipients after a two year course.

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Funding

This research was supported by German Research Foundation FOR 2240 “(Lymph) Angiogenesis And Cellular Immunity In Inflammatory Diseases Of The Eye” to CC and LMH (www.for2240.de) and EU COST BM 1302 “Joining Forces in Corneal Regeneration” to BOB and CC (www.biocornea.eu). The sponsor had no role in the design or implementation of this research.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Cologne, Kerpener Strasse 62 -, 50924, Cologne, Germany

    Friederike Schaub, Layla Pohl, Philip Enders, Björn O. Bachmann, Claus Cursiefen & Ludwig M. Heindl

  2. Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander, University Erlangen-Nürnberg, Erlangen, Germany

    Werner Adler

Authors
  1. Friederike Schaub
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  2. Layla Pohl
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  3. Philip Enders
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  4. Werner Adler
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  5. Björn O. Bachmann
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  6. Claus Cursiefen
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  7. Ludwig M. Heindl
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Corresponding author

Correspondence to Friederike Schaub.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Schaub, F., Pohl, L., Enders, P. et al. Impact of corneal donor lens status on two-year course and outcome of Descemet membrane endothelial keratoplasty (DMEK). Graefes Arch Clin Exp Ophthalmol 255, 2407–2414 (2017). https://doi.org/10.1007/s00417-017-3827-2

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  • DOI: https://doi.org/10.1007/s00417-017-3827-2

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