ArticleGraefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie2026
Predictors of graft survival after descemet membrane endothelial keratoplasty in eyes with severe corneal edema.
Article in Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo identify predictors of graft survival after Descemet membrane endothelial keratoplasty (DMEK) in eyes with severe corneal edema, with particular emphasis on modifiable intraoperative factors.
methodsThis 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.
resultsGraft 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).
conclusionsIn 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.
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