After Bilateral DMEK, Similar Long-Term Outcomes Are Likely in Both Eyes

A retrospective single-center evaluation of 5-year clinical outcomes following Descemet membrane endothelial keratoplasty (DMEK) suggests that similar results can be expected in each eye of patients who undergo sequential surgery, with relatively low rates of graft rejection or failure overall.

Study Design

This retrospective cohort study evaluated 181 patients (362 eyes) with Fuchs endothelial corneal dystrophy after sequential bilateral DMEK to compare outcomes between the two eyes, including intraoperative complications, graft survival, and endothelial cell density (ECD). All patients had reached 5 years of follow-up. A subgroup analysis was also performed that involved 59 patients who underwent bilateral surgery compared to 140 control patients who underwent single-eye surgery in order to evaluate decreased endothelial cell count in the primary eye after second-eye surgery.

Outcomes

Contralateral DMEK was performed an average of 15 months (range: 2–60 months) after DMEK in the first eye, with similar ECD, graft survival, and BCVA seen between the two eyes. Graft detachment requiring a rebubble occurred in 6% of all eyes (1% of patients required rebubbling in both eyes), and graft rejection occurred in 3% of all eyes (1% experienced bilateral rejection); differences between the 2 eyes were not statistically significant. In the subgroup analysis, ECD decrease in the first eye of patients who had bilateral surgery was similar to that seen in patients who had only single-eye surgery.

Limitations

A limitation to this study is the use of retrospective analysis rather than a prospective study to evaluate ECD decrease at the time of second-eye surgery. Additionally, the study is limited to a single center and to patients with Fuchs dystrophy; patients with diagnoses that confer higher graft rejection or failure risk may demonstrate different outcomes.

Clinical Significance

Clinical outcomes after bilateral DMEK appear to be similar between both eyes and overall show low rates of graft rejection or failure. Importantly, there was no significant decrease in ECD in the first graft after second-eye surgery, suggesting that a short time period (an average of 15 months in this study) is a reasonable time in which to operate on the second eye without concern for deterioration of the initial graft.

Financial Disclosures: Dr. Afshan Nanji discloses a financial relationship with Beyeonics Surgical (Consultant/Advisor).