{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T18:02:31Z","timestamp":1784916151131,"version":"3.55.0"},"reference-count":123,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"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>To identify pre\/perioperative factors that predict graft failure after Descemet membrane endothelial keratoplasty (DMEK).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included consecutive eyes that underwent DMEK in 2015\u20132023 in a regional referral hospital and were followed for at least 12 months. DMEK-graft failure was defined as need for regrafting during follow-up. Univariable analysis of graft-failure associations with 20 covariates was performed. Hierarchical multivariable analysis was conducted for DMEK-graft failure with covariates whose univariable-analysis p-values were \u22640.15. Posthoc univariable analyses were performed to elucidate the mechanisms by which covariates promoted DMEK-graft failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>171 eyes (129 patients) with mostly Fuchs endothelial corneal dystrophy (94%) were included. Median (range) follow-up was 24 (12\u201329) months, during which 15 grafts (9%) failed. On univariable analyses, graft failure associated with eight variables, including long (\u226525 mm) preoperative axial length (AXL): 40% of graft-failure eyes had AXL\u2009\u2265\u200925 mm vs. 13% for graft-success eyes (p\u2009=\u20090.01). On multivariable analysis, graft failure was predicted by AXL\u2009\u2265\u200925 mm (OR=5.70; 95%CI\u2009=\u20091.27\u201325.68; p\u2009=\u20090.02), younger graft-donor age (OR=0.93; 95%CI\u2009=\u20090.88\u20130.99; p\u2009=\u20090.02), graft-unscrolling\/positioning difficulties (OR=6.93; 95%CI\u2009=\u20091.58\u201330.48; p\u2009=\u20090.01), and major graft detachment (OR=6.28; 95%CI\u2009=\u20091.36\u201328.96; p\u2009=\u20090.02). The model accounted for 14% of total graft-failure variance. Posthoc univariable analysis showed that eyes with AXL\u2009\u2265\u200925 experienced graft-unscrolling\/positioning difficulties more often than shorter eyes (27% vs. 10%, p\u2009=\u20090.0497).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Eyes with long AXL (\u226525 mm) may be more prone to DMEK-graft failure than shorter eyes. This may reflect the deep anterior chamber, which can complicate graft unscrolling and\/or graft positioning. The additional graft handling may induce endothelial-cell loss and subsequent graft failure. Younger donor age weakly predicted DMEK-graft failure, possibly due to tighter scrolling of younger grafts. Major graft detachment strongly predicted DMEK-graft failure. This could reflect surgical and\/or rebubbling-induced endothelial damage and\/or pre-existing graft weakness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0352687","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T17:37:26Z","timestamp":1784914646000},"page":"e0352687","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative and perioperative factors that predict graft failure 1 year after Descemet membrane endothelial keratoplasty"],"prefix":"10.1371","volume":"21","author":[{"given":"Lucas","family":"Mastrangelo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jules","family":"Leterrier","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"}]},{"given":"Yinka","family":"Zevering","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":[[2026,7,24]]},"reference":[{"key":"pone.0352687.ref001","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1146\/annurev-vision-102016-061400","article-title":"EK 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