[Impact of the ratio between graft and host corneal size on immune rejection, re-bubbling rate and postoperative endothelial cell loss in 457 eyes after Descemet membrane endothelial keratoplasty (DMEK)]. / Einfluss des Verhältnisses von Transplantatgröße zu Hornhautgröße auf Immunreaktion, Re-Bubbling-Rate und postoperativen Endothelzellverlust bei 457 Augen nach Descemet-Membrane-Endothelial-Keratoplastik (DMEK).
Ophthalmologie
; 121(7): 565-570, 2024 Jul.
Article
in De
| MEDLINE
| ID: mdl-38639889
ABSTRACT
BACKGROUND:
The aim of this study was to assess the impact of the ratio between the graft and host corneal size (RGH) on postoperative complications, such as immune reactions, re-bubbling rate and endothelial cell loss (ECL) after Descemet membrane endothelial keratoplasty (DMEK). PATIENTS ANDMETHODS:
Retrospectively, 457 patient eyes were included which had undergone surgery between 2016 and 2019 in the Department of Ophthalmology, Saarland University Medical Center in Homburg/Saar using DMEK or triple DMEK, diagnosed as Fuchs' endothelial dystrophy (nâ¯= 431), pseudophakic bullous keratopathy (nâ¯= 9) and others (nâ¯= 17). The follow-up period extended until the end of 2020. Main outcome measures included immune reaction (IR), re-bubbling rate and the postoperative endothelial cell loss (ECL) at 6 weeks, 6 months and 12 months and whether these measures depended on the RGH.RESULTS:
The RGH in this study ranged from 0.35 to 0.62 (0.46⯱ 0.04). There were 33 (7.2%) postoperative IRs (DMEK nâ¯= 25; triple DMEK nâ¯= 8). The average RGH without IR (0.46⯱ 0.04) was significantly (pâ¯= 0.038) smaller than in the group with IR (0.47⯱ 0.05). Re-bubbling was necessary in 159 of 457 (34.8%) patient eyes. The RGH in patient eyes with re-bubbling (0.47⯱ 0.04) was significantly (pâ¯= 0.014) higher than that in eyes without re-bubbling (0.45⯱ 0.04). The mean preoperative endothelial cell count (ECD) was 2603⯱ 251 cells/mm2 (min 2161, max 3500 cells/mm2). It was shown that a larger RGH had no positive influence on endothelial cell loss (râ¯= 0.001; pâ¯= 0.974).CONCLUSION:
Our results suggest that a larger graft diameter compared to host corneal size is associated with an increased rate of immune reactions and a higher re-bubbling rate after DMEK. Otherwise, a larger RGH had no positive influence on endothelial cell loss after DMEK. Accordingly, the graft size for DMEK should not be unnecessarily large, especially in eyes with Fuchs' endothelial dystrophy.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Postoperative Complications
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Corneal Endothelial Cell Loss
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Descemet Stripping Endothelial Keratoplasty
/
Graft Rejection
Limits:
Adult
/
Aged
/
Aged80
/
Female
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Humans
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Male
/
Middle aged
Language:
De
Journal:
Ophthalmologie
Year:
2024
Document type:
Article
Country of publication:
Alemania