Five-Year Safety and Efficacy of Femtosecond Laser–Assisted Descemet Membrane Endothelial Keratoplasty

Abstract

The purpose of this study was to evaluate 5-year safety and efficacy outcomes of femtosecond-enabled Descemet membrane endothelial keratoplasty (F-DMEK) in patients with Fuchs' endothelial dystrophy (FED).Methods: This was a retrospective study, including patients with FED and cataract who underwent either F-DMEK (16 eyes of 15 patients) or manual DMEK (M-DMEK) (42 eyes of 37 patients) combined with cataract extraction. Outcome measures included visual acuity, graft detachment, graft survival, and endothelial cell loss. Results:The average follow-up in F-DMEK and M-DMEK was 57.1 6 12.4 months and 58.5 6 17.3 months, respectively (P = 0.757). The rates of primary failure (0% vs. 9.5%, P = 0.567), secondary failure (0% for both), and graft rejection (0% vs. 7.1%, P = 0.533) did not differ significantly between the groups. Improvement in best spectacle-corrected visual acuity was similar in F-DMEK and M-DMEK (0.32 6 0.27 logarithm of the minimum angle of resolution and 0.35 6 0.44 logarithm of the minimum angle of resolution, respectively, P = 0.165) and persisted at 2, 3, 4, and 5 years and at the last follow-up. The rates of graft detachment and rebubbling were significantly lower with 6.25% in F-DMEK and 33.3% in M-DMEK (P = 0.035). Cell-loss rates were lower in F-DMEK compared with M-DMEK throughout the follow-up, significantly so up to 2 years with a difference of 8.6% at 1 year (P = 0.023), 11.8% at 2 years (P = 0.021), 7.6% at 3 years (P = 0.088), 5.8% at 4 years (P = 0.256), 13.6% at 5 years (P = 0.169), and 7.1% at the final follow-up (P = 0.341).Conclusions: F-DMEK had an excellent safety and efficacy profile which was maintained over 5 years of follow-up. Lower endothelial cell-loss rates in F-DMEK compared with M-DMEK may help extend the duration of graft survival.

Long-term Outcomes After Lamellar Endothelial Keratoplasty Compared With Penetrating Keratoplasty for Corneal Endothelial Dysfunction: A Systematic Review

“…Therefore, we included 50 articles in our study (see Appendix 3, Supplemental Digital Content 3, http://links.lww.com/ICO/B504). 8,10,19–66…”

Advantages of femtosecond laser in various corneal transplantation procedures: A narrative literature review

“…[ 1 - 3 , 5 , 6 , 8 - 10 ] Many studies indicated that FSL can potentially improve both the visual and anatomical outcomes after various corneal transplantation surgeries, such as, PK, ALK, EK, and novel techniques including BL transplantation and SLAK. [ 17 , 29 , 44 , 49 - 52 , 68 - 71 , 88 ]…”

“…FSL-assisted DMEK was associated with a significantly decreased risk of graft detachment (6.25% vs. 33.3%, P = 0.035) and lower rate of ECD loss with a difference of 8.6% ( P = 0.023), 11.8% ( P = 0.021), 7.6% ( P = 0.088), 5.8% ( P = 0.256), and 13.6% ( P = 0.169) at 1, 2, 3, 4, and 5 years, respectively, than manual DMEK. [ 68 , 69 ] They also showed that FSL-assisted DMEK had a significantly reduced risk of graft detachment (10.0% vs. 65.5%, P = 0.003), rebubbling (10.0% vs. 58.6%, P = 0.011), and primary graft failure (0% vs. 27.6%, P = 0.086) than manual DMEK in eyes with previously failed PK. [ 70 , 71 ] A modified technique, FSL-assisted deep lamellar DMEK, can be a viable option for a particular range of indications, i.e.…”

“…[ 14 , 15 , 67 ] Sorkin et al . [ 68 , 69 ] reported that FSL-assisted DMEK showed excellent efficacy and safety over 5 years of follow-up. FSL-assisted DMEK was associated with a significantly decreased risk of graft detachment (6.25% vs. 33.3%, P = 0.035) and lower rate of ECD loss with a difference of 8.6% ( P = 0.023), 11.8% ( P = 0.021), 7.6% ( P = 0.088), 5.8% ( P = 0.256), and 13.6% ( P = 0.169) at 1, 2, 3, 4, and 5 years, respectively, than manual DMEK.…”

Risk Factors for Descemet Membrane Endothelial Keratoplasty Rejection: Current Perspectives- Systematic Review

“… Retrospective case series- 150 patients 150 eyes Mean age 71.7 ± 13.3 years, Mean preoperative visual acuity 1.09 ± 0.59 LogMAR Secondary glaucoma Conjunctival congestion, corneal edema, and AC reaction Topical steroids and repeat grafting Graft rejection incidence is 2.4% at 1 year and 9.2% at 3 years, Graft failure incidence is 5.5% at 1 year and 16.6% at 3 years 4 Jung et al 88 PLoS One 2022 Jun 30;17(6):e0270037. Retrospective case series- 32 patients 32 patients Mean age 64.5±11.1, mean preoperative LogMAR visual acuity 0.92±0.4 Fuch’s endothelial corneal dystrophy, Pseudophakic Bullous keratopathy Conjunctival congestion, corneal edema, and AC reaction Topical steroids and repeat grafting 4 patients with immunological failure, 2 patients with primary graft rejection 5 Sorkin et al 89 Cornea 2022 Mar 18 Retrospective analysis- 37 patients 42 eyes, Manual DMEK - Fuch’s endothelial corneal dystrophy, Pseudophakic Bullous keratopathy Conjunctival congestion, corneal edema, and AC reaction High-dose topical steroids Primary graft failure-9.5%, Secondary graft failure-0%, graft rejection-7.1% 6 Basak et al 38 Cornea, 2021 Nov 4. Retrospective analysis- 78 patients 80 eyes Mean donor age 83.6 ± 3.7 years (range: 80–100 years), mean recipient age 67.2 ± 6.9 years (range: 60–89 years), the preoperative value of 1.36 ± 0.67 Old age, low endothelial cell count Conjunctival congestion, corneal edema, and AC reaction Topical steroids Graft failure 2 eyes at 1 year, graft rejection 2 eyes, 1 reversed by medical management 7 Besek et al 12 Int Ophthalmol, 2022 Jan;42(1):269–279 Retrospective analysis 150 eyes Fuch’s Corne...…”