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To evaluate the clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed in the “oldest old” patients, i.e. ≥ 90 years.
Between the years of 2009 and 2019, 20 consecutive eyes of 17 patients aged ≥ 90 underwent DMEK for endothelial dysfunction. Best corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell density (ECD), graft survival, and intra- and postoperative complications were assessed.
Except in one case in which the DMEK surgery could not be completed, all operated eyes experienced an improvement in BCVA, although only 50% achieved ≥ 20/40 (0.5) by 1 year postoperatively. One year after surgery, median CCT had declined from 641(+/-161) μm to 480 (+/-34) μm (p<0.001), and median endothelial cell density was reduced by 53%, from 2574 (+/-286) to 1226 (+/-404) cells/mm2. Six of 19 eyes receiving DMEK grafts (32%) developed partial graft detachments requiring re-bubbling. One eye experienced a secondary graft failure at 6 months and underwent repeat endothelial keratoplasty.
DMEK is technically feasible in the oldest old patients and may yield significant visual improvements. Because clinical follow-up may be difficult for these patients, DMEK may be preferable to Descemet stripping endothelial keratoplasty and penetrating keratoplasty because the risk of suture related issues and allograft reaction/rejection is lower.
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.