Universität zu Köln

Hos, Deniz, Tuac, Onur, Schaub, Friederike, Stanzel, Tisha P., Schrittenlocher, Silvia ORCID: 0000-0001-6090-6777, Hellmich, Martin, Bachmann, Bjoern O. and Cursiefen, Claus (2017). Incidence and Clinical Course of Immune Reactions after Descemet Membrane Endothelial Keratoplasty Retrospective Analysis of 1000 Consecutive Eyes. Ophthalmology, 124 (4). S. 512 - 519. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1549-4713

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Abstract

Purpose: To analyze the incidence and clinical course of graft rejection episodes after Descemet membrane endothelial keratoplasty (DMEK). Design: Retrospective analysis of a consecutive, interventional case series. Participants: One thousand eyes that underwent DMEK from July 2011 through August 2015 at the Department of Ophthalmology, University of Cologne. Methods: All cases with follow-up of at least 1 month were included (mean follow-up, 18.5 months). Patients with a graft rejection episode were followed up for 1 additional year. Main Outcome Measures: Incidence of graft rejection, best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD), and need for regraft. Results: Nine hundred five cases met the inclusion criteria. A graft rejection episode developed in 12 patients (estimated probability of rejection at 1 year, 0.9%; at 2 years, 2.3%; at 4 years, 2.3%). At time of rejection, 9 of 12 patients had stopped corticosteroids. Five patients were symptomatic and 7 did not note the rejection episode. Intensified topical corticosteroid therapy was started immediately after diagnosis of rejection. Two eyes decompensated and required a regraft, whereas the remaining 10 eyes required no regraft (BSCVA, 0.27 +/- 0.28 logarithm of the minimum angle of resolution [logMAR]; CCT, 554.1 +/- 39.1 mu m at last visit before rejection vs. BSCVA, 0.21 +/- 0.15 logMAR; CCT, 540.0 +/- 15.0 mu m 3 months after rejection). One year after the rejection episodes, BSCVA and CCT in these eyes remained unchanged when compared with the last visit before rejection (BSCVA, 0.15 +/- 0.11 logMAR; CCT, 533.8 +/- 26.0 mu m). Significant changes were observed for ECD values (1741 +/- 274.5 cells/mm(2) at last visit before rejection vs. 1356 +/- 380.3 cells/mm(2) after 3 months [P = 0.04] and 1290 +/- 359.0 cells/mm(2) after 1 year [P = 0.01]). Conclusions: The risk for graft rejection afterDMEK is low, and an even smaller minority requires a regraft. After intensified local corticosteroid therapy, most patients show stable visual acuity and CCT, although ECD decreases. The occurrence of immune reactions up to 2 years after surgery predominantly in patients not receiving corticosteroids supports the prolonged use of corticosteroids after DMEK. (C) 2017 by the American Academy of Ophthalmology

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hos, Deniz UNSPECIFIED UNSPECIFIED UNSPECIFIED Tuac, Onur UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaub, Friederike UNSPECIFIED UNSPECIFIED UNSPECIFIED Stanzel, Tisha P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schrittenlocher, Silvia UNSPECIFIED orcid.org/0000-0001-6090-6777 UNSPECIFIED Hellmich, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Bachmann, Bjoern O. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cursiefen, Claus UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-235688
DOI:	10.1016/j.ophtha.2016.12.017
Journal or Publication Title:	Ophthalmology
Volume:	124
Number:	4
Page Range:	S. 512 - 519
Date:	2017
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1549-4713
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language 5-YEAR FOLLOW-UP; GRAFT-SURVIVAL; CELL DENSITY; REJECTION-EPISODES; MACULAR EDEMA; RISK; DMEK Multiple languages Ophthalmology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/23568