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Our study aims to assess donor and recipient risk factors as predictors of graft survival in a cohort of patients who have undergone DMEK at a single tertiary care center.
This is a retrospective cohort study of 308 eyes undergoing primary DMEK between January 2012 and June 2019 at a single North American tertiary care centre (i.e. the University of Ottawa Eye Institute). Clinical data on the following were collected and analyzed: demographic details, indications for DMEK surgery, ocular preoperative status and comorbidities, donor endothelial cell density (ECD), donor graft size, death to enucleation time, death to graft time, intra-operative complications and surgeon experience (i.e. cases performed within the first year). Statistical analyses were performed using univariable and multiple logistic regression with a significance level of 0.05.
In the univariable regression, prior glaucoma surgery including trabeculectomy and tube shunts (OR=2.4), intra-operative complications (OR=5.4) and surgeon experience (OR=3.8) were all associated with a greater risk of requiring repeat DMEK (P<0.05). Furthermore, a diagnosis of PBK was associated with a higher rate of graft failure (OR=2.8, P=0.003) while a diagnosis of Fuchs’ was a protective factor (OR=0.4, P=0.002). Donor graft size, ECD and death to enucleation and graft times were not associated with higher rates of failure. Multiple regression showed that only a diagnosis of Fuchs’ (OR=0.2, P=0.022) and higher donor age (OR=1.1, P=0.048) were independent predictors of graft failure.
An indication of PBK portends a higher risk of graft failure compared to Fuchs’. Donor factors are not significantly associated with a higher risk of graft failure, with the exception of increased donor age. Results from this study may benefit future patients by allowing better risk stratification and patient counseling prior to undergoing DMEK.
This presentation is from the session "SPS-101 Corneal Procedures & Diagnostics: EK, PK, CXL, Other" from the 2020 ASCRS Virtual Annual Meeting held on May 16-17, 2020.