Suryan L Dunker1, Manon H J Veldman2, Bjorn Winkens3, Frank J H M van den Biggelaar4, Rudy M M A Nuijts5, Pieter Jan Kruit6, Mor M Dickman4. 1. University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands. Electronic address: suryan.dunker@mumc.nl. 2. University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands. 3. Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands. 4. University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands. 5. Department of Ophthalmology, Zuyderland Medical Center, Heerlen, the Netherlands. 6. Euro Tissue Bank - Bio Implant Service (ETB-BISLIFE), Leiden, the Netherlands.
Abstract
PURPOSE: This study analyzed real-world practice patterns, graft survival, and outcomes of Descemet membrane endothelial keratoplasty (DMEK) in the Netherlands. DESIGN: Population-based interventional clinical study. METHODS: In this prospective registry study, all consecutive primary DMEK procedures registered in the Netherlands Organ Transplant Registry were identified. Short-term graft survival and outcomes of primary transplants for Fuchs' endothelial dystrophy (FED) were analyzed using Kaplan-Meier survival curves with log-rank test and Cox regression. Linear mixed model analyses were used for best spectacle-corrected visual acuity (BSCVA), spherical equivalent, hyperopic shift, and endothelial cell density. RESULTS: 752 DMEKs were identified between 2011 and 2018. In 90% of cases, the indication for DMEK was FED. Graft survival measured 87% at 3 months, 85% at 6 months, 85% at 1 year, and 78% at 2 years. DMEK procedures after 2015 showed better survival compared to previous years (Hazard ratio = 0.4; P < .001). Baseline BSCVA in primary transplants with FED measured on average 0.45 logarithm of the minimum angle of resolution (logMAR) (95% confidence interval [CI], 0.41-0.49), and significantly improved (overall P < .001) to 0.17 logMAR (95% CI, 0.14-0.21) at 3 months, 0.15 logMAR (95% CI, 0.11-0.18) at 6 months, 0.12 logMAR (95% CI, 0.08-0.16) at 1 year, and 0.08 (95% CI, 0.05-0.12) at 2 years. At 3 months, a hyperopic shift of +0.36 diopters (P < .001) was observed and endothelial cell loss measured 33%. CONCLUSION: Our findings provide real-world support that DMEK is an effective treatment for FED with respect to vision restoration, inducing a small hyperopic shift with an acceptable endothelial cell loss. Graft survival improved over time, suggesting a learning curve on a national level.
PURPOSE: This study analyzed real-world practice patterns, graft survival, and outcomes of Descemet membrane endothelial keratoplasty (DMEK) in the Netherlands. DESIGN: Population-based interventional clinical study. METHODS: In this prospective registry study, all consecutive primary DMEK procedures registered in the Netherlands Organ Transplant Registry were identified. Short-term graft survival and outcomes of primary transplants for Fuchs' endothelial dystrophy (FED) were analyzed using Kaplan-Meier survival curves with log-rank test and Cox regression. Linear mixed model analyses were used for best spectacle-corrected visual acuity (BSCVA), spherical equivalent, hyperopic shift, and endothelial cell density. RESULTS: 752 DMEKs were identified between 2011 and 2018. In 90% of cases, the indication for DMEK was FED. Graft survival measured 87% at 3 months, 85% at 6 months, 85% at 1 year, and 78% at 2 years. DMEK procedures after 2015 showed better survival compared to previous years (Hazard ratio = 0.4; P < .001). Baseline BSCVA in primary transplants with FED measured on average 0.45 logarithm of the minimum angle of resolution (logMAR) (95% confidence interval [CI], 0.41-0.49), and significantly improved (overall P < .001) to 0.17 logMAR (95% CI, 0.14-0.21) at 3 months, 0.15 logMAR (95% CI, 0.11-0.18) at 6 months, 0.12 logMAR (95% CI, 0.08-0.16) at 1 year, and 0.08 (95% CI, 0.05-0.12) at 2 years. At 3 months, a hyperopic shift of +0.36 diopters (P < .001) was observed and endothelial cell loss measured 33%. CONCLUSION: Our findings provide real-world support that DMEK is an effective treatment for FED with respect to vision restoration, inducing a small hyperopic shift with an acceptable endothelial cell loss. Graft survival improved over time, suggesting a learning curve on a national level.
Authors: Harry Levine; Paula A Sepulveda-Beltran; Diego S Altamirano; Alfonso L Sabater; Sander R Dubovy; Harry W Flynn; Guillermo Amescua Journal: Cornea Date: 2022-02-01 Impact factor: 2.651
Authors: Michael J Fliotsos; Jack A Campbell; Ximin Li; Marie B Engstrom; Christopher G Stoeger; Cathy McClory; Michael S Titus; Patrick Johnson; Kara B Johnston; Tim Fischer; Lisa K Brooks; Monty M Montoya; David B Glasser; Esen Karamursel Akpek; Divya Srikumaran Journal: Cornea Date: 2021-08-05 Impact factor: 3.152