Organ-cultured, prestripped donor tissue for DMEK surgery: clinical outcomes.

Abstract

To determine whether clinical performance is negatively affected by prestripping Descemet membrane endothelial keratoplasty (DMEK) grafts from organ-cultured corneas. We reviewed clinical records of all patients who underwent DMEK surgery for Fuchs endothelial dystrophy between 28 October 2014 and 11 August 2015. Grafts had been prepared from organ-cultured corneoscleral buttons 24 hours prior to surgery or during surgery. We included only patients for which at least one follow-up examination was available at a minimum of 2 months postoperatively. best-corrected visual acuity (BCVA), central corneal thickness, endothelial cell count and rebubbling rates. Data given are mean±SD. No statistically significant differences were recorded at baseline between the partially stripped group (n=65) and the control group (n=72) with regard to donor age (70±9 vs 69±8 years; p=0.49), donor cornea endothelial cell density (2586±604 vs 2522±186 cells/mm²; p=0.6), BCVA (before DMEK: 0.77±0.5 vs 0.63±0.3 logMAR; p=0.27; before triple-DMEK: 0.56±0.2 vs 0.52±0.2 logMAR; p=0.33) or central corneal thickness (621±72 vs 607±53 μm; p=0.49). Mean follow-up was 149±83 versus 148±77 days; p=0.79. No statistically significant differences were observed between the two groups postoperatively with regard to BCVA (after DMEK: 0.25±0.2 vs 0.21±0.2 logMAR; p=0.59; after triple-DMEK: 0.22±0.2 vs 0.2±0.1 logMAR; p=0.98), central corneal thickness (502±42 vs 508±41 μm; p=0.47), endothelial cell count (1537±245 vs 1551±287 cells/mm²; p=0.65) and number of graft detachments requiring rebubbling (4.6% vs 9.7%; p=0.33). We found no evidence that the use of prestripped DMEK grafts is inferior to same-day preparation in organ-cultured corneas within the given follow-up.