Impact of Donor Age on Descemet Membrane Endothelial Keratoplasty Outcome: Evaluation of Donors Aged 17–55 Years

doi:10.1016/j.ajo.2016.08.005

American Journal of Ophthalmology

Volume 170, October 2016, Pages 119-127

https://doi.org/10.1016/j.ajo.2016.08.005 Get rights and content

Purpose

To investigate whether the impression held by Descemet membrane endothelial keratoplasty (DMEK) surgeons that young donors are less suitable for DMEK is reflected in 1-year postoperative results.

Design

Retrospective, comparative, interventional case series.

Methods

Records of 1084 consecutive DMEKs were reviewed and matched with corresponding donor tissue data. Young donors (aged ≤55 years; subgroups: 10–40, 41–55) were compared with old donors (>55 years; subgroups: 56–65, >65). Outcome measures in DMEK recipients included best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), central corneal thickness (CCT) at 6 and 12 months, and rebubbling rate.

Results

Out of 529 included DMEKs, 94 (17.8%) were performed with young donor lamellae (mean donor age 49.31 ± 6.35 years; range: 17–55 years) and 435 (82.2%) with older donor tissue (mean age 70.68 ± 7.77 years; range: 56–90 years). Postoperative BSCVA, ECD, and CCT results were comparable in both groups at 6 and 12 months without statistically significant differences. Overall rebubbling rate in the young donor group was 42.6% and in the old donors was 53.3% (P = .058). Complication rates also did not differ significantly.

Conclusion

Younger donor age seems not to affect the clinical outcome of DMEK surgery negatively within the first postoperative year, suggesting donor corneas with donor age down to 17 years as safe donor tissue for DMEK surgery.

Section snippets

Methods

In this retrospective study, we reviewed clinical records of 1084 consecutively performed DMEKs for endothelial pathologies between July 1, 2011 and November 30, 2015 at the Department of Ophthalmology, University of Cologne, Cologne, Germany. The data have been prospectively compiled within the Cologne DMEK database, using REDCap electronic data capture tools. REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies.¹⁷

Results

Clinical records of 1084 consecutively performed DMEKs in eyes with endothelial pathologies were reviewed; 529 cases (48.8%) met all inclusion and no exclusion criteria and were available for further analyses. Out of these 529 cases, 94 (17.8%) could be assigned to the young donor group (donor age ≤55 years), whereas 435 (82.2%) could be assigned to the old donor group (>55 years).

Discussion

Descemet membrane endothelial keratoplasty has become the superior form of endothelial keratoplasty in routine cases of corneal endothelial diseases in several countries worldwide. Despite obvious advantages over DSAEK, such as less graft rejection and faster visual recovery, graft preparation was suggested to be one of the most important technical limitations of DMEK.8, 21, 22 Donor tissue characteristics that contribute to major complications of donor preparation or graft implantation, such

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Factors Affecting the Success Rate of Preloaded Descemet Membrane Endothelial Keratoplasty With Endothelium-Inward Technique: A Multicenter Clinical Study
2022, American Journal of Ophthalmology
To evaluate factors affecting the outcomes of preloaded Descemet membrane endothelial keratoplasty (pl-DMEK) with endothelium-inward.
Retrospective clinical case series and a comparative tissue preparation study.
Participants: Fifty-five donor tissues for ex vivo study and 147 eyes of 147 patients indicated with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy with or without cataract.
Intervention: Standardized DMEK peeling was performed with 9.5-mm-diameter trephination followed by second trephination for loading the graft (8.0-9.5 mm diameter). The tissues were manually preloaded with endothelium-inward and preserved for 4 days or shipped for transplantation. Live and dead assay and immunostaining was performed on ex vivo tissues. For the clinical study, the tissues were delivered using bimanual pull-through technique followed by air tamponade at all the centers.
Main outcome measures: Tissue characteristics, donor and recipient factors, rebubbling rate, endothelial cell loss (ECL), and corrected distance visual acuity (CDVA) at 3, 6, and 12 months.
At day 4, significant cell loss (P = .04) was observed in pl-DMEK with loss of biomarker expression seen in prestripped and pl-DMEK tissues. Rebubbling was observed in 40.24% cases. Average ECL at 3, 6, and 12 months was 45.87%, 40.98%, and 47.54%, respectively. CDVA improved significantly at 3 months postoperation (0.23 ± 0.37 logMAR) (P < .01) compared to the baseline (0.79 ± 0.61 logMAR). A significant association (P < .05) between graft diameter, preservation time, recipient gender, gender mismatch, and recipient age to rebubbling rate was observed.
Graft loading to delivery time of pl-DMEK tissues in endothelium-inward fashion must be limited to 4 days after processing. Rebubbling rate and overall surgical outcomes following preloaded DMEK can be multifactorial and center-specific.
Cost-Effectiveness of Antifungal Supplementation of Corneal Cold Storage Media
2020, Ophthalmology
Citation Excerpt :
The base case consisted of a 70-year-old binocular male patient with Fuch’s endothelial dystrophy in both eyes undergoing a first eye corneal transplant, with the partial-thickness or full-thickness corneal graft being stored in antibiotic-supplement CSM or antifungal and antibiotic-supplemented CSM.16-18 The age in the reference case was the mean age of patients with Fuch’s endothelial dystrophy undergoing corneal transplants in previously published studies, and the study was performed over a 16-year time horizon based on the average life expectancy of the patient in the base case undergoing a corneal transplant; the complications were based on previously published studies (Table 1).19-21 A variety of antifungals were evaluated because there is currently no consensus on the preferred antifungal prophylaxis or dosage.
To evaluate the cost-effectiveness of supplementing hypothermic cold storage media (CSM) with antifungal therapy.
Cost-effectiveness analysis (CEA).
Base case of a patient with Fuch’s endothelial dystrophy undergoing a first eye keratoplasty.
Cost-effective analysis of the base case with corneal tissue stored in CSM or CSM supplemented with antifungal therapy over a 16-year time horizon. Multiple clinical scenarios were considered, including endothelial keratoplasty (EK) and penetrating keratoplasty (PK); amphotericin B, voriconazole, caspofungin, and combination therapy; and third-party payer and societal perspectives. The incidences were derived from PubMed literature searches and average wholesale prices of medications; all costs were discounted 3% per annum and adjusted for inflation to 2019 US dollars.
Incremental cost-effectiveness ratios (ICERs).
In the reference case, a corneal endothelial graft stored in amphotericin B–supplemented CSM was the most cost-effective approach from a third-party payer and societal perspective. Probability sensitivity analysis (PSA) of the societal model for the EK was robust, with 93.5% being below an arbitrary willingness-to-pay threshold (WTP) of $20 000 per fungal infection averted. Voriconazole, caspofungin, and combination antifungals were less cost-effective than amphotericin B. The main factors influencing the CEA were the incidences of postkeratoplasty fungal infections, potential increases in graft failures, and antifungal costs. For grafts intended for PKs, antifungal supplementation was less cost-effective than for EKs.
Antifungal supplementation with amphotericin B for EK grafts was the most cost-effective approach of the studied antifungals; however, the CEA was sensitive to potential changes in graft failure rates, underlining the importance of long-term safety studies. For full-thickness corneal grafts, antifungal supplementation was less cost-effective.
Outcome of Descemet Membrane Endothelial Keratoplasty Using Corneas from Donors ≥80 Years of Age
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Citation Excerpt :
This warrants studies of the feasibility and safety of DMEK surgeries with “imperfect” donor corneas. The present authors were previously able to show in this context that donor tissues of young corneal donors (17-55 years of age) can safely be used for DMEK surgery and that clinical outcomes are comparable to those from older donors.9 Furthermore, the authors could also demonstrate that pseudophakic transplants using high-EC densities seemed to produce functional results comparable those using phakic donor tissue.19
The purpose of this study was to investigate whether corneas from donors ≥80 years old are suitable for Descemet membrane endothelial keratoplasty (DMEK).
Retrospective, comparative, interventional case series.
Records of 1,765 consecutive DMEKs were reviewed and matched with corresponding donor tissue data. Older donors (≥80 years of age) were compared to younger donors (<80 years). Outcome measurements in DMEK recipients included best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), central corneal thickness (CCT) at 3 and 6 months and at 1, 2, and 3 years' follow-up and re-bubbling rates.
Of 1,748 DMEKs, 284 (16.2%) were performed with older donor lamellae (mean donor age, 83.96 ± 3.19 years; range, 80-94 years) and 1,464 (83.7%) with younger donor tissue (mean donor age, 65.27 ± 9.57 years; range, 17-79). BSCVA results were comparable for all postoperative time points. CCT results for younger donors were more favorable in the early postoperative course (P < 0.001 at 6 months; and P < 0.001 at 1 year), whereas mid-term results were comparable in both groups. ECD values were significantly higher in donors <80 years of age preoperatively and during the first 2 postoperative years (P ≤ 0.024). Overall re-bubbling rates were comparable in both groups.
Older donors, ≥80 to 94 years of age, seem to produce comparable mid-term functional results following DMEK surgery compared to younger donors. The use of corneas from donors aged ≥80 for DMEK surgery may therefore be a promising approach to counteract global donor shortage.
Donor Characteristics in Graft Detachment after Posterior Lamellar Keratoplasty for Fuchs Endothelial Dystrophy and Bullous Keratopathy
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Risk factors for early graft detachment requiring rebubbling in Descemet membrane endothelial keratoplasty with imported pre-cut donor tissues
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Original articleImpact of Donor Age on Descemet Membrane Endothelial Keratoplasty Outcome: Evaluation of Donors Aged 17–55 Years

Purpose

Design

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Ophthalmology

J Cataract Refract Surg

J Cataract Refract Surg

Ophthalmology

Ophthalmology

Ophthalmology

Descemet membrane endothelial keratoplasty: the taming of the shrew

JAMA Ophthalmol

Descemet-stripping automated endothelial keratoplasty

Cornea

Posterior lamellar keratoplasty: DLEK to DSEK to DMEK

Cornea

[Treatment of corneal endothelial disorders by DMEK and UT-DSAEK: indications, complications, results and follow-up]

Ophthalmologe

[DMEK: Descemet membrane endothelial keratoplasty]

Ophthalmologe

[Prevention and management of complications in Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK)]

Ophthalmologe

Donor tissue characteristics in preparation of DMEK grafts

Cornea

Influence of donor characteristics on Descemet membrane endothelial keratoplasty

Cornea

Descemet membrane endothelial keratoplasty as treatment for graft failure after descemet stripping automated endothelial keratoplasty

Am J Ophthalmol

[Influence of donor lamella thickness on visual acuity after Descemet's stripping automated endothelial keratoplasty (DSAEK)]

Ophthalmologe

Original article
Impact of Donor Age on Descemet Membrane Endothelial Keratoplasty Outcome: Evaluation of Donors Aged 17–55 Years