Deniz Hos1, Onur Tuac2, Friederike Schaub2, Tisha P Stanzel3, Silvia Schrittenlocher2, Martin Hellmich4, Björn O Bachmann2, Claus Cursiefen5. 1. Department of Ophthalmology, University of Cologne, Cologne, Germany; Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany. Electronic address: deniz.hos@uk-koeln.de. 2. Department of Ophthalmology, University of Cologne, Cologne, Germany. 3. Singapore Eye Research Institute, Singapore, Republic of Singapore. 4. Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany. 5. Department of Ophthalmology, University of Cologne, Cologne, Germany; Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.
Abstract
PURPOSE: To analyze the incidence and clinical course of graft rejection episodes after Descemet membrane endothelial keratoplasty (DMEK). DESIGN: Retrospective analysis of a consecutive, interventional case series. PARTICIPANTS: One thousand eyes that underwent DMEK from July 2011 through August 2015 at the Department of Ophthalmology, University of Cologne. METHODS: All cases with follow-up of at least 1 month were included (mean follow-up, 18.5 months). Patients with a graft rejection episode were followed up for 1 additional year. MAIN OUTCOME MEASURES: Incidence of graft rejection, best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD), and need for regraft. RESULTS: Nine hundred five cases met the inclusion criteria. A graft rejection episode developed in 12 patients (estimated probability of rejection at 1 year, 0.9%; at 2 years, 2.3%; at 4 years, 2.3%). At time of rejection, 9 of 12 patients had stopped corticosteroids. Five patients were symptomatic and 7 did not note the rejection episode. Intensified topical corticosteroid therapy was started immediately after diagnosis of rejection. Two eyes decompensated and required a regraft, whereas the remaining 10 eyes required no regraft (BSCVA, 0.27±0.28 logarithm of the minimum angle of resolution [logMAR]; CCT, 554.1±39.1 μm at last visit before rejection vs. BSCVA, 0.21±0.15 logMAR; CCT, 540.0±15.0 μm 3 months after rejection). One year after the rejection episodes, BSCVA and CCT in these eyes remained unchanged when compared with the last visit before rejection (BSCVA, 0.15±0.11 logMAR; CCT, 533.8±26.0 μm). Significant changes were observed for ECD values (1741±274.5 cells/mm2 at last visit before rejection vs. 1356±380.3 cells/mm2 after 3 months [P = 0.04] and 1290±359.0 cells/mm2 after 1 year [P = 0.01]). CONCLUSIONS: The risk for graft rejection after DMEK is low, and an even smaller minority requires a regraft. After intensified local corticosteroid therapy, most patients show stable visual acuity and CCT, although ECD decreases. The occurrence of immune reactions up to 2 years after surgery predominantly in patients not receiving corticosteroids supports the prolonged use of corticosteroids after DMEK.
PURPOSE: To analyze the incidence and clinical course of graft rejection episodes after Descemet membrane endothelial keratoplasty (DMEK). DESIGN: Retrospective analysis of a consecutive, interventional case series. PARTICIPANTS: One thousand eyes that underwent DMEK from July 2011 through August 2015 at the Department of Ophthalmology, University of Cologne. METHODS: All cases with follow-up of at least 1 month were included (mean follow-up, 18.5 months). Patients with a graft rejection episode were followed up for 1 additional year. MAIN OUTCOME MEASURES: Incidence of graft rejection, best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD), and need for regraft. RESULTS: Nine hundred five cases met the inclusion criteria. A graft rejection episode developed in 12 patients (estimated probability of rejection at 1 year, 0.9%; at 2 years, 2.3%; at 4 years, 2.3%). At time of rejection, 9 of 12 patients had stopped corticosteroids. Five patients were symptomatic and 7 did not note the rejection episode. Intensified topical corticosteroid therapy was started immediately after diagnosis of rejection. Two eyes decompensated and required a regraft, whereas the remaining 10 eyes required no regraft (BSCVA, 0.27±0.28 logarithm of the minimum angle of resolution [logMAR]; CCT, 554.1±39.1 μm at last visit before rejection vs. BSCVA, 0.21±0.15 logMAR; CCT, 540.0±15.0 μm 3 months after rejection). One year after the rejection episodes, BSCVA and CCT in these eyes remained unchanged when compared with the last visit before rejection (BSCVA, 0.15±0.11 logMAR; CCT, 533.8±26.0 μm). Significant changes were observed for ECD values (1741±274.5 cells/mm2 at last visit before rejection vs. 1356±380.3 cells/mm2 after 3 months [P = 0.04] and 1290±359.0 cells/mm2 after 1 year [P = 0.01]). CONCLUSIONS: The risk for graft rejection after DMEK is low, and an even smaller minority requires a regraft. After intensified local corticosteroid therapy, most patients show stable visual acuity and CCT, although ECD decreases. The occurrence of immune reactions up to 2 years after surgery predominantly in patients not receiving corticosteroids supports the prolonged use of corticosteroids after DMEK.
Authors: M Matthaei; S Schrittenlocher; D Hos; S Siebelmann; F Bucher; F Schaub; R Hoerster; R Siggel; S Roters; L M Heindl; B Bachmann; C Cursiefen Journal: Ophthalmologe Date: 2019-03 Impact factor: 1.059