Purpose:The purpose of this study is to analyze the course of corneal densitometry (CD), endothelial cell density (ECD), best-corrected visual acuity (BCVA), and central corneal thickness (CCT) 5 years after uneventful Descemet membrane endothelial keratoplasty (DMEK).Methods:Sixty uneventful cases (51 patients) with a minimum follow-up of 5 years were included. CD of various corneal layers (anterior, central, posterior, and total layer) and zones (0–2 mm, 2–6 mm, and 6–10 mm) were measured with Scheimpflug tomography. ECD, BCVA, and CCT were also evaluated.Results:Total CD at 0 to 2 mm and 2 to 6 mm zones significantly decreased from 33 ± 10 and 27.8 ± 8 grayscale units (GSU) preoperatively to 21.8 ± 3.1 and 22.2 ± 4.2 GSU at 5 years, respectively (P < 0.001). On the contrary, total CD at the 6 to 10 mm zone significantly increased from 30 ± 8.3 GSU preoperatively to 34.6 ± 7.8 GSU at 5 years (P < 0.001). ECD significantly decreased from 2496 ± 267 cells/mm2 preoperatively to 1063 ± 470 cells/mm2 at 5 years (P < 0.001). Similarly, CCT significantly decreased from 686 ± 109 μm preoperatively to 557 ± 37 μm at 5 years (P < 0.001). Postoperative BCVA was significantly better after DMEK for every examination time point.Conclusions:Despite a slight CD increase at all layers of all corneal zones from the second to the fifth postoperative year, the excellent visual outcome was maintained throughout 5-year follow-up. Thus, DMEK seems to effectively treat corneal endothelial disease in the long term.

We read with interest the article by Sinha et al. regarding IOP agreement between I-care TA01 rebound tonometer and the Goldmann applanation tonometry (GAT) in eyes with and without glaucoma [1]. The authors conclude that the two methods cannot be used interchangeably due to large limits of agreement.There is, however, a significant point to make regarding methodology in this study. The authors do not describe exactly how IOP measurements were made: Did both independent masked and experienced ophthalmologists measure IOP with both instruments? What was the inter-observer and intra-observer agreement in their measurements? Most importantly, the order in which RT and GAT were performed is not mentioned, and it is not described whether or not the examiner measured IOP with GAT once or if a repeated measurement was made and a mean calculated, as is preferred by several authors [2,3].Rebound tomometry (RT) has been found to overestimate IOP compared to GAT when RT is used first but not when used immediately after GAT [4]. This difference may have significant implications in the study by Sinha et al.: if RT was consistently used after repeated GAT measurements, then this could account for, at least in part, the large limits of agreement found between the two methods in the higher range of intraocular pressures.

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