One-year outcomes in eyes remaining phakic after Descemet membrane endothelial keratoplasty

PURPOSE: To assess 1-year outcomes in patients remaining phakic after Descemet membrane endothelial keratoplasty (DMEK). SETTING: Private clinic, Indianapolis, Indiana, USA. DESIGN: Interventional case series. METHODS: Data on consecutive DMEK cases with retention of the crystalline lens were reviewed. The outcome measures were development or progression of postoperative lens opacity, performance of cataract extraction, endothelial cell loss, and corrected distance visual acuity (CDVA) at 1 year. The rate of and risk factors for cataract formation and extraction were analyzed using multivariate proportional hazards modeling and Kaplan-Meier survival analysis. RESULTS: Of the 49 eyes, 15 (31%) had trace nuclear sclerosis and 34 (69%) had clear lenses preoperatively. The median patient age was 50 years. Forty-eight eyes (98%) were treated for Fuchs dystrophy. The median follow-up after DMEK was 12 months. All grafts cleared and remained clear. Cataract progression occurred postoperatively in 37 eyes (76%); cataract surgery was performed in 16 eyes (33%). Patients older than 50 years had a higher risk for cataract progression after DMEK (P=.0094). The median endothelial cell loss was 25% within the first year. The median CDVA was 20/20 at 1 year. CONCLUSIONS: Descemet membrane endothelial keratoplasty accelerated the natural rate of cataract formation, consistent with data on other types of corneal transplantation including penetrating keratoplasty and Descemet-stripping automated endothelial keratoplasty. Patients older than 50 years had higher risk for cataract progression than younger patients. The majority of patients achieved 20/20 CDVA.