Patients who undergo DMEK at an older age may be more likely to have worse visual acuity.

Patients who undergo DMEK at an older age may be more likely to have worse visual acuity. Photo: Aaron Bronner, OD. Click image to enlarge.

For the first time, researchers investigated the predictive ability of routinely collected demographic and clinical factors on final visual acuity after Descemet membrane endothelial keratoplasty (DMEK). They found that older age was associated with worse visual acuity after DMEK.

The researchers conducted a retrospective cohort study of 100 consecutive patients (mean age 72) with Fuchs endothelial corneal dystrophy who underwent DMEK (pseudophakic patients) or triple-DMEK (DMEK combined with cataract surgery). Surgery was considered successful if BCVA at 12 months was ≤0.1 logMAR.

The researchers used the following clinical factors for their multivariate analysis: patient age and sex, graft donor age, triple DMEK, preoperative BCVA, endothelial cell density (ECD), central corneal thickness (CCT), mean anterior keratometry and rebubbling. They reported that 81% of patients had a successful surgery and that older age was a significant predictor for 12-month BCVA >0.1 logMAR (OR: 0.914).

The researchers wrote in their paper that this association of older age and poorer post-DMEK visual acuity outcomes “supports the notion that DMEK should be performed without delay when symptoms arise.” Though sex, donor age, triple DMEK and anterior keratometry weren’t significant predictors of visual acuity after DMEK, the researchers noted a weak predictive link between preoperative visual acuity and final visual acuity.

Additionally, they wrote, “While preoperative ECD and CCT and rebubbling may not play strong roles as visual acuity predictors, they’re occasionally detected as predictors in the literature, possibly because of an underlying ECD-visual acuity axis that can be detected in specific cohort and peri/postoperative settings.”

 Bloch F, Dinot V,  Goetz C, et al. Ability of routinely collected clinical factors to predict good visual acuity results after primary Descemet membrane endothelial keratoplasty: a cohort study. BMC Ophthalmol. August 24, 2022. [Epub ahead of print].