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Incidence of Early Allograft Rejection After Descemet Membrane Endothelial Keratoplasty

Dapena, Isabel MD; Ham, Lisanne MSc; Netuková, Magdaléna MD, PhD; van der Wees, Jacqueline PhD; Melles, Gerrit R J MD, PhD

doi: 10.1097/ICO.0b013e31820d8540
Clinical Science

Purpose: To report the incidence of early allograft rejection after Descemet membrane endothelial keratoplasty (DMEK), that is, transplantation of isolated Descemet membrane with its endothelium.

Methods: The first series of 120 eyes of 105 patients operated on for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy, with an average 2 years of follow-up after 9.0- to 10.0-mm-diameter DMEK, enrolled in our study.

Results: During the entire study period, only 1 of the eyes showed any signs of a cellular immune response to the Descemet graft. A 76-year-old patient presented with discomfort, reduced visual acuity to counting fingers, corneal decompensation, and a Khodadoust line in the central cornea 4 months after (decentered) DMEK. Intensified topical corticoid therapy resulted in a complete visual recovery to 20/25 (0.8) within weeks.

Conclusions: A “classic” allograft rejection (with an appearance similar to that after penetrating keratoplasty) can occur after DMEK. However, compared with the earlier (endothelial) keratoplasty procedures, DMEK may be associated with a lower rejection rate of ≤1%, despite transplant diameters of ±9.5 mm. The apparent immune tolerance in DMEK may result from either less “upregulation” or more “downregulation” of the immune system.

From the *Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; †Melles Cornea Clinic, Rotterdam, The Netherlands; ‡Amnitrans EyeBank, Rotterdam, The Netherlands; and §Department of Ophthalmology, Vinohrady Teaching Hospital, Prague, Czech Republic.

Received for publication August 19, 2010; revision received December 21, 2010; accepted December 26, 2010.

The authors state that they have no financial or conflicts of interest to disclose.

Dr Melles is a consultant for D.O.R.C. International/Dutch Ophthalmic, USA.

Reprints: Dr Gerrit R. J. Melles, Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands 3071 AA (e-mail:

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