Predictors of graft survival after descemet membrane endothelial keratoplasty in eyes with severe corneal edema
GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s00417-026-07551-3
- Dergi Adı: GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest)
- Gazi Üniversitesi Adresli: Evet
Özet
Purpose To identify predictors of graft survival after Descemet membrane endothelial keratoplasty (DMEK) in eyes with severe corneal edema, with particular emphasis on modifiable intraoperative factors. Methods This retrospective cohort study included 112 consecutive eyes undergoing DMEK between 2014 and 2024 with at least 12 months of follow-up and available intraoperative videos. Donor, recipient, preoperative, and perioperative variables were reviewed, and intraoperative timings, including the duration of complete unfolding, were quantified from surgical recordings. Logistic regression was used to identify predictors of graft failure. Receiver operating characteristic analysis determined the optimal threshold, and graft survival was assessed using Kaplan-Meier and Cox regression analyses. Results Graft failure developed in 24/112 eyes (21.4%) after a mean of 14.5 +/- 16.1 months. The duration of complete unfolding was longer in eyes that developed graft failure (median 12.0 vs. 8.0 min; p = 0.034) and emerged as the only independent predictor in multivariable analysis (adjusted OR 1.11, 95% CI 1.01-1.21; p = 0.029). An unfolding time > 11 min showed moderate discrimination for graft failure (AUC 0.654, 95% CI 0.550-0.748; p = 0.045) and was associated with poorer graft survival (HR 3.24, 95% CI 1.45-7.24; p = 0.004). Conclusions In eyes with severe corneal edema undergoing DMEK, prolonged complete unfolding time was the only independent predictor of graft failure. Eyes with prolonged or difficult unfolding may merit closer postoperative follow-up.