Survival of Grafts up to 10 years After Descemet Membrane Endothelial Keratoplasty

Purpose: To evaluate graft survival and postoperative outcomes up to 10 years after Descemet membrane endothelial keratoplasty (DMEK). Methods: A retrospective analysis of 2521 DMEK cases assessed graft preparation, perioperative complications, and outcomes including endothelial cell count (ECC), visual acuity (VA), and central corneal thickness. Patients were grouped into successful DMEK (sDMEK; n = 2201) and those needing repeat keratoplasty (re-graft; n = 320). Results: The Kaplan–Meier estimated graft survival at 10 years was 0.86. Pseudophakic donors were more frequent in re-grafts ( P = 0.002; hazard ratio 1.74), although donor ECC and age were comparable. Preexisting glaucoma, glaucoma surgery, and pseudophakic bullous keratopathy were more common in the re-graft group (all P < 0.001; hazard ratio 1.47, 1.73, 1.78, respectively). Intraoperative graft preparation time and handling showed no significant differences. Postoperatively, re-graft cases had higher rates of rebubbling, graft flipping, and further surgeries (all P < 0.001). In sDMEK, VA and central corneal thickness improved significantly by 4 to 6 weeks and remained stable up to 10 years (n = 40; P = 0.84, P = 0.76). ECC decreased by 33% at 1 month ( P < 0.001) and by 47% at 10 years ( P = 0.18). Conclusions: This long-term analysis confirms DMEK as a durable and effective technique with stable visual outcomes. Although the overall success rate is high, patients with glaucoma or complex anterior segment conditions may experience reduced graft survival and increased endothelial cell loss.