Three-year follow-up of eye bank prepared pre-loaded DMEK vs. pre-cut UT-DSAEK grafts

Purpose: To compare the difference of long-term clinical outcomes between eye bank prepared pre-loaded (pl)-DMEK (endo-in technique) and pre-cut (pc)-ultra-thin (UT)-DSAEK grafts. Method: In this retrospective single center interventional case series, patients were treated for Fuchs endothelial corneal dystrophy (FECD) using pl-DMEK (n=47) and pc-UT-DSAEK grafts (n=42). The grafts were prepared, loaded and transported in an IOL cartridge (pl-DMEK) or in the storage media (pc-UT-DSAEK) by a single eye-bank. All the grafts were delivered by a single surgeon using bimanual pull-through technique. Post-operative outcomes were monitored up to 3 years. The main outcome measures were early post-operative complications, best corrected visual acuity (BCVA) and endothelial cell density (ECD) at years 1, 2 and 3. Result: pl-DMEK showed a significantly higher rebubbling rate (21.3%) compared to pc-UT-DSAEK (4.8%; p < 0.001). pl-DMEK group showed a significant improvement in visual acuity (logMAR) at years 1 (0.06 vs 0.13), 2 (0.05 vs 0.12) and 3 (0.05 vs 0.12) (p < 0.05) compared to the pc-UT-DSAEK group. Mean endothelial cell density (cells/mm2) of pl-DMEK grafts did not differ (p > 0.05) compared to pc-UT-DSAEK grafts at year 1 (1745 vs 1789), year 2 (1553 vs 1495) and year 3 (1422 vs 1280). Conclusion: Despite higher immediate post-operative complications in pl-DMEK, long-term clinical outcomes remain comparable or better than pc-UT-DSAEK grafts. Eye bank prepared grafts are therefore safe and reliable for challenging EK procedures.