Ten-year outcomes after DMEK, DSAEK, and PK: insights on graft survival, endothelial cell density loss, rejection and visual acuity
Abstract Fuchs Endothelial Corneal Dystrophy (FECD) is the most frequent indication for corneal transplantation, with Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping automated endothelial keratoplasty (DSAEK), and penetrating keratoplasty (PK) being viable options. This retrosp...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2025-01-01
|
| Series: | Scientific Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1038/s41598-025-85138-4 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841544845919780864 |
|---|---|
| author | Theresa Isabelle Wilhelm Laura Gauché Daniel Böhringer Philip Maier Sonja Heinzelmann Mateusz Glegola Paola Kammrath Betancor Thomas Reinhard |
| author_facet | Theresa Isabelle Wilhelm Laura Gauché Daniel Böhringer Philip Maier Sonja Heinzelmann Mateusz Glegola Paola Kammrath Betancor Thomas Reinhard |
| author_sort | Theresa Isabelle Wilhelm |
| collection | DOAJ |
| description | Abstract Fuchs Endothelial Corneal Dystrophy (FECD) is the most frequent indication for corneal transplantation, with Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping automated endothelial keratoplasty (DSAEK), and penetrating keratoplasty (PK) being viable options. This retrospective study compared 10-year outcomes of these techniques in a large cohort of 2956 first-time keratoplasty eyes treated for FECD at a high-volume corneal transplant center in Germany. While DMEK and DSAEK provided faster visual recovery (median time to BSCVA ≥ 6/12 Snellen: DMEK 7.8 months, DSAEK 12.4 months, PK 37.9 months; cumulative probability of BSCVA ≥ 6/12 Snellen within 5 years: DMEK 93%, DSAEK 83%, PK 63%), PK surprisingly exhibited superior long-term graft survival (92% vs. 75% for DMEK and 73% for DSAEK at 10 years). Endothelial cell density (ECD) decreased significantly faster after DMEK and DSAEK, potentially contributing to their lower graft survival (10-year ECD > 1000 cells/mm2 probability: DMEK 3%, DSAEK 8%, PK 18%). DMEK demonstrated the lowest rejection rate (10% at 10 years vs. 13% for PK and 19% for DSAEK). These findings challenge the perceived superiority of endothelial keratoplasty and highlight the need for further investigation into the long-term implications of accelerated endothelial cell loss after DMEK and DSAEK. |
| format | Article |
| id | doaj-art-c53395290aac4c88b24564aeb23bb36d |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-c53395290aac4c88b24564aeb23bb36d2025-01-12T12:15:03ZengNature PortfolioScientific Reports2045-23222025-01-0115111210.1038/s41598-025-85138-4Ten-year outcomes after DMEK, DSAEK, and PK: insights on graft survival, endothelial cell density loss, rejection and visual acuityTheresa Isabelle Wilhelm0Laura Gauché1Daniel Böhringer2Philip Maier3Sonja Heinzelmann4Mateusz Glegola5Paola Kammrath Betancor6Thomas Reinhard7Eye Center, Medical Center, Faculty of Medicine, University of FreiburgEye Center, Medical Center, Faculty of Medicine, University of FreiburgEye Center, Medical Center, Faculty of Medicine, University of FreiburgEye Center, Medical Center, Faculty of Medicine, University of FreiburgEye Center, Medical Center, Faculty of Medicine, University of FreiburgEye Center, Medical Center, Faculty of Medicine, University of FreiburgEye Center, Medical Center, Faculty of Medicine, University of FreiburgEye Center, Medical Center, Faculty of Medicine, University of FreiburgAbstract Fuchs Endothelial Corneal Dystrophy (FECD) is the most frequent indication for corneal transplantation, with Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping automated endothelial keratoplasty (DSAEK), and penetrating keratoplasty (PK) being viable options. This retrospective study compared 10-year outcomes of these techniques in a large cohort of 2956 first-time keratoplasty eyes treated for FECD at a high-volume corneal transplant center in Germany. While DMEK and DSAEK provided faster visual recovery (median time to BSCVA ≥ 6/12 Snellen: DMEK 7.8 months, DSAEK 12.4 months, PK 37.9 months; cumulative probability of BSCVA ≥ 6/12 Snellen within 5 years: DMEK 93%, DSAEK 83%, PK 63%), PK surprisingly exhibited superior long-term graft survival (92% vs. 75% for DMEK and 73% for DSAEK at 10 years). Endothelial cell density (ECD) decreased significantly faster after DMEK and DSAEK, potentially contributing to their lower graft survival (10-year ECD > 1000 cells/mm2 probability: DMEK 3%, DSAEK 8%, PK 18%). DMEK demonstrated the lowest rejection rate (10% at 10 years vs. 13% for PK and 19% for DSAEK). These findings challenge the perceived superiority of endothelial keratoplasty and highlight the need for further investigation into the long-term implications of accelerated endothelial cell loss after DMEK and DSAEK.https://doi.org/10.1038/s41598-025-85138-4DMEKDSAEKPenetrating keratoplastyCorneal transplantationFuchs endothelial corneal dystrophyGraft survival |
| spellingShingle | Theresa Isabelle Wilhelm Laura Gauché Daniel Böhringer Philip Maier Sonja Heinzelmann Mateusz Glegola Paola Kammrath Betancor Thomas Reinhard Ten-year outcomes after DMEK, DSAEK, and PK: insights on graft survival, endothelial cell density loss, rejection and visual acuity Scientific Reports DMEK DSAEK Penetrating keratoplasty Corneal transplantation Fuchs endothelial corneal dystrophy Graft survival |
| title | Ten-year outcomes after DMEK, DSAEK, and PK: insights on graft survival, endothelial cell density loss, rejection and visual acuity |
| title_full | Ten-year outcomes after DMEK, DSAEK, and PK: insights on graft survival, endothelial cell density loss, rejection and visual acuity |
| title_fullStr | Ten-year outcomes after DMEK, DSAEK, and PK: insights on graft survival, endothelial cell density loss, rejection and visual acuity |
| title_full_unstemmed | Ten-year outcomes after DMEK, DSAEK, and PK: insights on graft survival, endothelial cell density loss, rejection and visual acuity |
| title_short | Ten-year outcomes after DMEK, DSAEK, and PK: insights on graft survival, endothelial cell density loss, rejection and visual acuity |
| title_sort | ten year outcomes after dmek dsaek and pk insights on graft survival endothelial cell density loss rejection and visual acuity |
| topic | DMEK DSAEK Penetrating keratoplasty Corneal transplantation Fuchs endothelial corneal dystrophy Graft survival |
| url | https://doi.org/10.1038/s41598-025-85138-4 |
| work_keys_str_mv | AT theresaisabellewilhelm tenyearoutcomesafterdmekdsaekandpkinsightsongraftsurvivalendothelialcelldensitylossrejectionandvisualacuity AT lauragauche tenyearoutcomesafterdmekdsaekandpkinsightsongraftsurvivalendothelialcelldensitylossrejectionandvisualacuity AT danielbohringer tenyearoutcomesafterdmekdsaekandpkinsightsongraftsurvivalendothelialcelldensitylossrejectionandvisualacuity AT philipmaier tenyearoutcomesafterdmekdsaekandpkinsightsongraftsurvivalendothelialcelldensitylossrejectionandvisualacuity AT sonjaheinzelmann tenyearoutcomesafterdmekdsaekandpkinsightsongraftsurvivalendothelialcelldensitylossrejectionandvisualacuity AT mateuszglegola tenyearoutcomesafterdmekdsaekandpkinsightsongraftsurvivalendothelialcelldensitylossrejectionandvisualacuity AT paolakammrathbetancor tenyearoutcomesafterdmekdsaekandpkinsightsongraftsurvivalendothelialcelldensitylossrejectionandvisualacuity AT thomasreinhard tenyearoutcomesafterdmekdsaekandpkinsightsongraftsurvivalendothelialcelldensitylossrejectionandvisualacuity |