Donor and recipient characteristics associated with rebubbling rate, endothelial cell loss, and graft failure in primary descemet membrane endothelial keratoplasty

Aim: To determine whether donor and recipient characteristics are associated with rebubbling rate, endothelial cell loss (ECL), and graft failure 3 years after primary Descemet membrane endothelial keratoplasty (DMEK). Material and Method: Records of 295 consecutive DMEK surgery and match with corresponding donor data were reviewed at a tertiary referral clinic. Recipients with intraoperative complications and coexisting ocular pathologies were excluded. Age, sex of donor and recipient, cause of donor death, death-to-preservation time (DtPT), storage time, donor endothelial cell density (ECD), and indications for surgery were analyzed for correlation with rebubbling rate, postoperative ECL, and graft failure. Further, subgroup analyses of the cause of death, donor sex, DtPT (median value, 3.5 h), and indications were performed. Multiple regression and receiver operating characteristics (ROC) analysis were used to determine the independent risk factors for graft failure. Results: This study included 114 eyes that underwent DMEK for bullous keratopathy (BK; 64%) and for Fuchs’ endothelial corneal dystrophy (FECD; 36%). The graft failure percentage was the only parameter that was higher in patients with DtPT > 3.5 h (p=0.047) than those with shorter DtPT. The probability of graft failure was seven times higher in eyes with DtPT > 3.5 h than with shorter DtPT (odds ratio 7.36, 95% confidence interval CI 1.34‒40.53) and 10 times higher in eyes with BK than those with FECD (odds ratio 10.29, 95% CI 1.01‒104.54). Conclusion:. DtPT and recipients with BK diagnosis were found to be independent risk factors for graft failure. Therefore, surgeons should consider DtPT for DMEK in eyes with BK.