Bilateral Descemet Membrane Endothelial Keratoplasty: Analysis of Clinical Outcome in First and Fellow Eye

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To analyze the clinical outcomes, complications, comparability, and predictors of sequential bilateral Descemet membrane endothelial keratoplasty (DMEK).


Retrospective analyses were completed on 60 patients (120 eyes) with corneal endothelial disorders who underwent bilateral sequential DMEK. Main outcome measures were best-corrected visual acuity (BCVA), pachymetry, endothelial cell density, rebubbling frequency, and graft or nongraft-associated complications—as measured 6 and 12 months after surgery.


BCVA, pachymetry, and endothelial cell loss did not differ significantly 6 and 12 months after surgery in first versus fellow eyes (P > 0.05, respectively). Graft and nongraft-associated complications such as graft detachment, graft failure, graft rejection, anterior chamber inflammation, and intraocular pressure decompensation did not differ significantly between first and fellow eyes (P > 0.05, respectively). The BCVA of first eyes 6 and 12 months after surgery correlates significantly with the 12-month BCVA of fellow eyes (r = 0.454, P = 0.031; r = 0.602, P = 0.001, respectively). Nevertheless, it was not possible to identify BCVA as an influencing variable on fellow eye outcome in regression modeling. Early sequential DMEK did not increase patients' risk of early immune reactions in their fellow eyes.


The clinical outcomes of first and fellow eyes were comparable in patients after DMEK. This suggests patients will experience good fellow eye outcomes after successful first eye DMEK. When certain quality characteristics are maintained, donor differences do not significantly affect DMEK results. We found no significant correlation in postoperative complications in first and fellow eye DMEK surgeries.

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