Outcomes of descemet's membrane endothelial keratoplasty in patients under thirty years old

Background Evidence for Descemet's membrane endothelial keratoplasty (DMEK) in patients under 30 years old remains limited, although understanding outcomes in this demographic is important given the requirement for decades of graft function and concerns about long-term DMEK survival. Methods We conducted a retrospective case series at Moorfields Eye Hospital of consecutive patients under 30 years undergoing DMEK between 2015 and 2022. Primary outcome was change in best-corrected visual acuity (BCVA). Secondary outcomes included change in central corneal thickness (CCT), graft failure rates, and post-operative complications. Results 18 eyes of 17 patients underwent DMEK surgery (mean age 22.7 ± 5.1) over a mean follow-up of 1072.1 ± 869.8 days. Mean BCVA improvement was 0.36 logMAR from pre-operative to final follow-up ( p > 0.05), though significant improvements occurred at 1-month and 12-month intervals ( p < 0.001 and p < 0.01, respectively). CCT improved significantly from baseline by 111.3 μm (95% CI, 64.3–158.2 μm, p < 0.0001). At final follow-up, 22.2% of eyes achieved BCVA ≤ 0.3 logMAR ( n = 4). No patient achieved BCVA ≤ 0.1 logMAR. Rebubbling was performed 9 times (50%) in 8 eyes and was similar between both SF6 and air ( p > 0.05). Post-operative complications occurred in 11.1% ( n = 2) with no rejection episodes, although secondary graft failure occurred in 22.2% ( n = 4), all within 12 months. Conclusions DMEK effectively improves visual and anatomical outcomes in patients under 30, though with higher complication rates than older populations. The complex pathology and longer follow-up requirements in this demographic necessitate careful patient selection and realistic expectations. Larger prospective studies are needed to establish definitive guidelines for this population.