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Risk of Corneal Transplant Rejection Significantly Reduced with Descemet's Membrane Endothelial Keratoplasty.
MedLine Citation:
PMID:  22218143     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: To evaluate the relative risk of immunologic rejection episode in patients who underwent Descemet's membrane endothelial keratoplasty (DMEK), Descemet's stripping endothelial keratoplasty (DSEK), and penetrating keratoplasty (PK). DESIGN: Comparative case series. PARTICIPANTS: One hundred forty-one eyes treated with DMEK at Price Vision Group, Indianapolis, Indiana. METHODS: The patients in the DMEK group were compared retrospectively with cohorts of DSEK (n = 598) and PK (n = 30) patients treated at the same center, with similar demographics, follow-up duration, and indications for surgery. The postoperative steroid regimen and rejection criteria were identical in the 3 groups. Kaplan-Meier survival analysis, which takes varying length of follow-up into consideration, was performed to determine the cumulative probability of a rejection episode 1 and 2 years after surgery. Proportional hazards analysis was used to determine the relative risk of rejection episodes between the 3 groups. P<0.05 was considered significant and calculated using the log-rank test. MAIN OUTCOME MEASURES: Rejection-free survival and cumulative probability of a rejection episode. RESULTS: The mean recipient age was 66 years (56% females and 94% Caucasian) and median follow-up duration was 13 months (range, 3-40) in the DMEK group. Fuchs' dystrophy was the most common indication for surgery (n = 127; 90%) followed by pseudophakic bullous keratopathy (n = 4; 4%) and regrafts (n = 9; 6.4%). Only 1 patient (0.7%) had a documented rejection episode in the DMEK group compared with 54 (9%) in the DSEK and 5 (17%) in the PK group. The Kaplan-Meier cumulative probability of a rejection episode at 1 and 2 years was 1% and 1%, respectively, for DMEK; 8% and 12%, respectively, for DSEK; and 14% and 18%, respectively, for PK. This was a highly significant difference (P = 0.004). The DMEK eyes had a 15 times lesser risk of experiencing a rejection episode than DSEK eyes (95% confidence limit [CL], 2.0-111; P = 0.008) and 20 times lower risk than PK eyes (95% CL, 2.4-166; P = 0.006). CONCLUSIONS: Patients undergoing DMEK had a significantly reduced risk of experiencing a rejection episode within 2 years after surgery compared with DSEK and PK performed for similar indications using the same corticosteroid regimen. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.
Authors:
Arundhati Anshu; Marianne O Price; Francis W Price
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-2
Journal Detail:
Title:  Ophthalmology     Volume:  -     ISSN:  1549-4713     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Affiliation:
Cornea Research Foundation of America, Indianapolis, Indiana; Price Vision Group, Indianapolis, Indiana.
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