{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T15:09:58Z","timestamp":1793718598914,"version":"4.6.1"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T00:00:00Z","timestamp":1703116800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>The long-term clinical outcomes, postoperative complications, and graft survival of Descemet<jats:bold>-<\/jats:bold>membrane endothelial keratoplasty (DMEK) remain poorly understood. We retrospectively assessed these variables in all consecutive eyes that underwent DMEK for any indication in 2014\u20132018. The findings were compared to the long-term DMEK studies of five other groups (3\u201310-year follow-up).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Patients underwent ophthalmological tests preoperatively, at 1, 3, 6, and 12 postoperative months, and then annually. Five-year graft survival was determined by Kaplan-Meier estimator. Change in best-corrected visual acuity (BCVA), endothelial-cell density (ECD), and central-corneal thickness (CCT) at each timepoint was determined.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>107 eyes (80 patients; 72 years old; 67% female) underwent first-time DMEK for uncomplicated Fuchs endothelial corneal dystrophy (94% of eyes), pseudophakic bullous keratopathy (3%), and regraft after previous keratoplasty (3%). The most common complication was graft detachment requiring rebubbling (18%). Thirteen grafts (12%) failed at \u226415 months. Cumulative 5-year graft-survival probability was 88% (95% confidence intervals = 79\u201394%). BCVA improved from 0.6 logMAR preoperatively to 0.05 logMAR at 1 year (p&lt;0.0001) and then remained stable. Donor ECD dropped by 47% at 6 postoperative months and then continued to decrease by 4.0%\/year. Five-year endothelial-cell loss was 65% (from 2550 to 900 cells\/mm<jats:sup>2<\/jats:sup>). CCT dropped from 618 to 551 \u03bcm at 5 years (p&lt;0.0001). These findings are generally consistent with previous long-term DMEK studies.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>DMEK has low complication and high graft-survival rates and excellent clinical outcomes that persist up to 5 years post-surgery. DMEK seems to be a safe and effective treatment in the long term.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0295434","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T18:30:55Z","timestamp":1703183455000},"page":"e0295434","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":18,"title":["Five-year clinical outcomes of 107 consecutive DMEK surgeries"],"prefix":"10.1371","volume":"18","author":[{"given":"Pierre","family":"Bichet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00e9mi","family":"Moskwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8381-2607","authenticated-orcid":true,"given":"Christophe","family":"Goetz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2966-0251","authenticated-orcid":true,"given":"Yinka","family":"Zevering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Charles","family":"Vermion","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1427-7567","authenticated-orcid":true,"given":"Jean-Marc","family":"Perone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,12,21]]},"reference":[{"key":"pone.0295434.ref001","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1097\/00003226-200404000-00011","article-title":"A technique to excise the descemet membrane from a recipient cornea (descemetorhexis).","volume":"23","author":"GRJ Melles","year":"2004","journal-title":"Cornea"},{"key":"pone.0295434.ref002","first-page":"987","article-title":"Descemet membrane endothelial keratoplasty (DMEK).","volume":"25","author":"GRJ Melles","year":"2006","journal-title":"Cornea"},{"key":"pone.0295434.ref003","first-page":"321","article-title":"Fuchs endothelial corneal dystrophy: Current perspectives","volume":"10","author":"G Vedana","year":"2016","journal-title":"Clinical Ophthalmology"},{"key":"pone.0295434.ref004","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1007\/BF01986362","article-title":"Dystrophia epithelialis corneae.","volume":"76","author":"E. Fuchs","year":"1910","journal-title":"Graefes Arhiv f\u00fcr Ophthalmologie"},{"key":"pone.0295434.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/ICL.0000000000000469","article-title":"Fuchs Endothelial Corneal Dystrophy: Update on Pathogenesis and Future Directions.","volume":"45","author":"C Sarnicola","year":"2019","journal-title":"Eye Contact Lens."},{"key":"pone.0295434.ref006","doi-asserted-by":"crossref","first-page":"90","DOI":"10.22336\/rjo.2017.17","article-title":"Pseudophakic bullous keratopathy.","volume":"61","author":"S Pricopie","year":"2017","journal-title":"Rom J Ophthalmol"},{"key":"pone.0295434.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0263686","article-title":"Evolution of corneal transplantation techniques and their indications in a French corneal transplant unit in 2000\u20132020.","volume":"17","author":"V Malleron","year":"2022","journal-title":"PLoS One."},{"key":"pone.0295434.ref008","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1111\/j.1442-9071.2005.01134.x","article-title":"Centennial review of corneal transplantation","volume":"33","author":"S Moffatt","year":"2005","journal-title":"Clin Exp Ophthalmol"},{"key":"pone.0295434.ref009","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.ajo.2020.06.023","article-title":"Real-World Outcomes of DMEK: A Prospective Dutch registry study","volume":"222","author":"SL Dunker","year":"2021","journal-title":"Am J Ophthalmol"},{"key":"pone.0295434.ref010","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1007\/s00417-015-3248-z","article-title":"Outcomes of Descemet membrane endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty from a single centre study","volume":"254","author":"S Heinzelmann","year":"2016","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"pone.0295434.ref011","first-page":"0","article-title":"Immune reactions after modern lamellar (DALK, DSAEK, DMEK) versus conventional penetrating corneal transplantation.","volume":"73","author":"D Hos","year":"2019","journal-title":"Prog Retin Eye Res"},{"key":"pone.0295434.ref012","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1097\/00003226-199811000-00010","article-title":"A surgical technique for posterior lamellar keratoplasty","volume":"17","author":"GR Melles","year":"1998","journal-title":"Cornea"},{"key":"pone.0295434.ref013","first-page":"1","article-title":"Descemet\u2019s membrane endothelial keratoplasty is the predominant keratoplasty procedure in Germany since 2016: a report of the DOG-section cornea and its keratoplasty registry.","author":"Collaborators GKRSG","year":"2023","journal-title":"British Journal of Ophthalmology"},{"key":"pone.0295434.ref014","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1007\/s00417-015-2939-9","article-title":"Influence of the difficulty of graft unfolding and attachment on the outcome in descemet membrane endothelial keratoplasty","volume":"253","author":"AKB Maier","year":"2015","journal-title":"Graefe\u2019s Archive for Clinical and Experimental Ophthalmology"},{"key":"pone.0295434.ref015","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1097\/ICO.0000000000001069","article-title":"Experienced DSAEK Surgeon\u2019s Transition to DMEK: Outcomes Comparing the Last 100 DSAEK Surgeries With the First 100 DMEK Surgeries Exclusively Using Previously Published Techniques","volume":"36","author":"PM Phillips","year":"2017","journal-title":"Cornea"},{"key":"pone.0295434.ref016","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.ajo.2016.07.002","article-title":"Long-term Clinical Outcome After Descemet Membrane Endothelial Keratoplasty","volume":"169","author":"A Schl\u00f6gl","year":"2016","journal-title":"Am J Ophthalmol"},{"key":"pone.0295434.ref017","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.ajo.2016.08.038","article-title":"Midterm Results of Descemet Membrane Endothelial Keratoplasty: 4 to 7 Years Clinical Outcome","volume":"171","author":"L Ham","year":"2016","journal-title":"Am J Ophthalmol"},{"key":"pone.0295434.ref018","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1097\/ICO.0000000000002120","article-title":"Five-Year Graft Survival and Clinical Outcomes of 500 Consecutive Cases After Descemet Membrane Endothelial Keratoplasty","volume":"39","author":"RS Birbal","year":"2020","journal-title":"Cornea"},{"key":"pone.0295434.ref019","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ajo.2020.04.005","article-title":"Descemet Membrane Endothelial Keratoplasty: Ten-Year Graft Survival and Clinical Outcomes","volume":"217","author":"I Vasiliauskait\u0117","year":"2020","journal-title":"Am J Ophthalmol"},{"key":"pone.0295434.ref020","article-title":"Long-Term Results after DMEK (Descemet\u2019s Membrane Endothelial Keratoplasty).","author":"R. Wardeh","year":"2020","journal-title":"Phillip-Universitat, Marburg, Germany."},{"key":"pone.0295434.ref021","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s10792-021-02078-4","article-title":"Graft survival and clinical outcomes of Descemet membrane endothelial keratoplasty: long-term results.","volume":"42","author":"NK Be\u015fek","year":"2022","journal-title":"Int Ophthalmol"},{"key":"pone.0295434.ref022","article-title":"Descemet membrane endothelial keratoplasty: analysis of clinical outcomes of patients with 8\u201310 years follow-up.","author":"J Weller","year":"2022","journal-title":"Int Ophthalmol."},{"key":"pone.0295434.ref023","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/ICO.0000000000002737","article-title":"Long-Term Outcome of Descemet Membrane Endothelial Keratoplasty in Eyes With Fuchs Endothelial Corneal Dystrophy Versus Pseudophakic Bullous Keratopathy","volume":"41","author":"SB Zwingelberg","year":"2022","journal-title":"Cornea"},{"key":"pone.0295434.ref024","first-page":"987","article-title":"Descemet membrane endothelial keratoplasty (DMEK).","volume":"25","author":"GRJ Melles","year":"2006","journal-title":"Cornea"},{"key":"pone.0295434.ref025","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.jfo.2019.03.002","article-title":"Supracapsular phacoemulsification: Description of the \u201cGarde \u00e0 vous\u201d technique and comparative clinical results.","volume":"42","author":"J-M Perone","year":"2019","journal-title":"J Fr Ophtalmol"},{"key":"pone.0295434.ref026","doi-asserted-by":"crossref","first-page":"661","DOI":"10.3928\/1081597X-20200729-02","article-title":"Refractive Outcomes of Descemet Membrane Endothelial Keratoplasty Combined With Cataract Surgery in Fuchs Endothelial Dystrophy.","volume":"36","author":"SS Bae","year":"2020","journal-title":"J Refract 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Fajardo-Sanchez","year":"2021","journal-title":"Cornea"},{"key":"pone.0295434.ref034","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.ophtha.2017.08.015","article-title":"Descemet Membrane Endothelial Keratoplasty: Safety and Outcomes: A Report by the American Academy of Ophthalmology","volume":"125","author":"SX Deng","year":"2018","journal-title":"Ophthalmology"},{"key":"pone.0295434.ref035","article-title":"Descemet membrane endothelial keratoplasty: analysis of clinical outcomes of patients with 8\u201310 years follow-up.","author":"J Weller","year":"2022","journal-title":"Int Ophthalmol."},{"key":"pone.0295434.ref036","first-page":"1","article-title":"Rebubbling and graft failure in Descemet membrane endothelial keratoplasty: a prospective Dutch registry study","author":"S Dunker","year":"2021","journal-title":"British Journal of Ophthalmology"},{"key":"pone.0295434.ref037","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s10792-021-02078-4","article-title":"Graft survival and clinical outcomes of Descemet membrane endothelial keratoplasty: long-term results.","volume":"42","author":"NK Be\u015fek","year":"2022","journal-title":"Int Ophthalmol"},{"key":"pone.0295434.ref038","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1097\/ICO.0000000000002120","article-title":"Five-Year Graft Survival and Clinical Outcomes of 500 Consecutive Cases After Descemet Membrane Endothelial Keratoplasty","volume":"39","author":"RS Birbal","year":"2020","journal-title":"Cornea"},{"key":"pone.0295434.ref039","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1097\/ICO.0000000000001950","article-title":"Risk Factors for Cystoid Macular Edema After Descemet Membrane Endothelial Keratoplasty","volume":"38","author":"S Inoda","year":"2019","journal-title":"Cornea"},{"key":"pone.0295434.ref040","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/ICO.0000000000001501","article-title":"Incidence of Cystoid Macular Edema after Descemet Membrane Endothelial Keratoplasty","volume":"37","author":"V Kocaba","year":"2018","journal-title":"Cornea"},{"key":"pone.0295434.ref041","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1097\/ICO.0000000000001176","article-title":"Two-Year Clinical Outcome of 500 Consecutive Cases Undergoing Descemet Membrane Endothelial Keratoplasty","volume":"36","author":"J Peraza-Nieves","year":"2017","journal-title":"Cornea"},{"key":"pone.0295434.ref042","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.ophtha.2018.05.019","article-title":"Descemet Endothelial Thickness Comparison Trial: A Randomized Trial Comparing Ultrathin Descemet Stripping Automated Endothelial Keratoplasty with Descemet Membrane Endothelial Keratoplasty","volume":"126","author":"W Chamberlain","year":"2018","journal-title":"Ophthalmology"},{"key":"pone.0295434.ref043","first-page":"19","article-title":"Comparison of endothelial cell loss and complications following DMEK with the use of three different graft injectors","volume":"32","author":"K Droutsas","year":"2018","journal-title":"Eye (Basingstoke)."},{"key":"pone.0295434.ref044","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajo.2020.05.003","article-title":"Endothelial Cell Loss After Descemet\u2019s Membrane Endothelial Keratoplasty for Fuchs\u2019 Endothelial Dystrophy: DMEK Compared to Triple DMEK.","volume":"218","author":"D Shahnazaryan","year":"2020","journal-title":"Am J Ophthalmol"},{"key":"pone.0295434.ref045","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1016\/j.jcrs.2014.04.023","article-title":"Air reinjection and endothelial cell density in Descemet membrane endothelial keratoplasty: Five-year follow-up","volume":"40","author":"MT Feng","year":"2014","journal-title":"J Cataract Refract Surg"},{"key":"pone.0295434.ref046","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.sjopt.2017.02.009","article-title":"Age related changes in corneal morphological characteristics of healthy Pakistani eyes","volume":"31","author":"QU Islam","year":"2017","journal-title":"Saudi Journal of Ophthalmology"},{"key":"pone.0295434.ref047","doi-asserted-by":"crossref","first-page":"264","DOI":"10.3390\/clinpract13010024","article-title":"An Overview of Corneal Transplantation in the Past Decade.","volume":"13","author":"M Musa","year":"2023","journal-title":"Clin Pract"}],"container-title":["PLOS 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