DMEK graft rejection lowest among transplant techniques

May 9, 2012

The 2-year immunologic graft rejection rate for Descemet's membrane endothelial keratoplasty was the lowest among four types of cornea transplants used for treatment of endothelial dysfunction in a single-center study, said Marianne O. Price, PhD.

Fort Lauderdale, FL-The 2-year immunologic graft rejection rate for Descemet’s membrane endothelial keratoplasty (DMEK) was the lowest among four types of cornea transplants used for treatment of endothelial dysfunction in a single-center study, said Marianne O. Price, PhD.

The rejection-free survival rate for DMEK was 99.4%; it was 95% for Descemet’s membrane automated endothelial keratoplasty (DMAEK), 88% for Descemet’s stripping endothelial keratoplasty (DSEK), and 82% for penetrating keratoplasty, said Dr. Price, PhD, executive director of the Cornea Research Foundation of America, Indianapolis.

Dr. Price also noted that the relative risk of experiencing a rejection episode was 6 times lower with DMEK than DMAEK and 2.8 times lower with DMAEK than DSEK. Prospective data on cases was collected at the Price Vision Institute in Indianapolis; studies at other groups have had similar results.

“The implications are that DMEK has an incredibly low rejection rate,” she said. “This is an amazing benefit that we can offer our patients, and it may allow us for the first time to cut back on our use of corticosteroids and reduce the incidence of corticosteroid-associated side effects.”

Corticosteroids are used off-label in cornea transplants, and in the absence of randomized studies there is a wide range in frequency of dosing and the duration of use.

“With DMEK we feel that we have an opportunity to improve steroids’ benefit-to-risk ratio for our patients, so we’ve filed a physician-sponsored investigational new drug application with the FDA and have designed a prospective randomized study to compare steroid regimens with DMEK,” Dr. Price said.

The primary outcome is graft rejection, and the secondary outcome is IOP.

About 140 patients of the 440 needed for statistical power have been enrolled.

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