Endothelial Cell Failure of DSAEK + DMEK Re-Grafts: A Retrospective Chart Review -5520
Mon statut pour la session
Author’s Disclosure Block: Rachel Martin, none; Veronica Pentland, none; Wilma Hopman, none; Stephanie Baxter, none; Davin Johnson, none
Abstract Body
Purpose: While DMEK and DSAEK corneal transplants can be an effective solution for improving vision and pain after endothelial cell failure, a subset of patients experience graft failure within a few years, necessitating repeat endothelial transplantation. There is a paucity of evidence in the literature as to what factors affect success or failure in this population of patients with repeat grafts. The primary objective of this study was to identify secondary failure (endothelial cell failure) rates for re-graft DMEK and DSAEK transplants. Secondary objectives were to identify factors that lead to success or failure for re-graft transplants. Study Design: Retrospective chart review Methods: We performed a retrospective study analyzing initial DMEK and DSAEK grafts at our centre between 2017 – 2023 with endothelial graft failure leading to a repeat DMEK or DSAEK graft between 2018 – 2024. Ethics approval was obtained from the Queen's University Health Sciences &Affiliated Teaching Hospitals Research Ethics Board (HSREB). Our study included patients operated on by two corneal surgeons, with both grafts performed by the same surgeon. Inclusion criteria included original DMEK or DSAEK grafts performed for endothelial cell failure from either Fuch’s dystrophy, glaucoma surgery-associated cell loss or pseudophakic bullous keratopathy. Exclusion criteria included grafts that failed due to lack of attachment. Patient demographics, past ocular and medical history, ocular surgical history, post-surgical course, intraocular pressure, eye drop use and donor graft characteristics were extracted. Results: Our study included 22 eyes from 21 patients who had a repeat corneal DMEK or DSAEK graft. 77.3% were from endothelial failure after glaucoma surgery, 9.1% had typical pseudophakic bullous keratopathy and 13.6% were Fuchs’ dystrophy patients. Of the repeat grafts, 36.4% had repeat endothelial graft failure during the study period. Mean time since 1st graft surgery to graft failure was 2.11 years. Of the 5 patients necessitating 3 grafts, 40% of the third grafts failed during the study timeline. Repeat grafts that were DSAEK had lower failure rates (12.5%) vs. DMEK grafts (50%), which was approaching significance (Fisher Exact Test, p = 0.167). Timolol use showed a statistically significant protective effective (15.4% repeat graft failure on timolol vs 66.7% failure without timolol, Fisher Exact Test p = 0.026). Conclusions: Repeat endothelial transplants have high rates of failure when performed for endothelial failure of the first graft. DSAEK grafts as a repeat graft may have lower failure rates and timolol may have a protective effect.