Descemet membrane endothelial keratoplasty: graft rejection, failure and survival

Abstract

Within the past two decades, full thickness penetrating keratoplasty (PK) has been largely supplanted by lamellar endothelial keratoplasty (EK) procedures that have revolutionized the treatment of corneal endothelial diseases such as Fuchs endothelial dystrophy. Since the introduction of EK in 1998, these techniques have undergone continuous transition, from Deep lamellar endothelial keratoplasty (DLEK) to Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK) and eventually to Descemet membrane endothelial keratoplasty (DMEK). While the graft in DLEK and DSEK/DSAEK consists of endothelium, Descemet membrane and stroma, in DMEK only an isolated Descemet membrane with its endothelium, devoid of stroma, is transplanted. Notably, the thinner graft used in DMEK may have three main advantages over earlier techniques: Faster and better visual rehabilitation, predictable small refractive change, and a reduced risk of immunologic reactions. This thesis will investigate the clinical outcomes after DMEK, the latest refinement of lamellar endothelial keratoplasty techniques. The focus will be on DMEK graft survival and on allograft rejection (and its prediction), a complication that may potentially lead to graft failure and hereby reduce the overall survival probability.