ArticlePloS one2026
Preoperative and perioperative factors that predict graft failure 1 year after Descemet membrane endothelial keratoplasty.
Article in PloS one, 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 pre/perioperative factors that predict graft failure after Descemet membrane endothelial keratoplasty (DMEK).
methodsThis retrospective cohort study included consecutive eyes that underwent DMEK in 2015-2023 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 ≤0.15. Posthoc univariable analyses were performed to elucidate the mechanisms by which covariates promoted DMEK-graft failure.
results171 eyes (129 patients) with mostly Fuchs endothelial corneal dystrophy (94%) were included. Median (range) follow-up was 24 (12-29) months, during which 15 grafts (9%) failed. On univariable analyses, graft failure associated with eight variables, including long (≥25 mm) preoperative axial length (AXL): 40% of graft-failure eyes had AXL ≥ 25 mm vs. 13% for graft-success eyes (p = 0.01). On multivariable analysis, graft failure was predicted by AXL ≥ 25 mm (OR=5.70; 95%CI = 1.27-25.68; p = 0.02), younger graft-donor age (OR=0.93; 95%CI = 0.88-0.99; p = 0.02), graft-unscrolling/positioning difficulties (OR=6.93; 95%CI = 1.58-30.48; p = 0.01), and major graft detachment (OR=6.28; 95%CI = 1.36-28.96; p = 0.02). The model accounted for 14% of total graft-failure variance. Posthoc univariable analysis showed that eyes with AXL ≥ 25 experienced graft-unscrolling/positioning difficulties more often than shorter eyes (27% vs. 10%, p = 0.0497).
conclusionsEyes with long AXL (≥25 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.
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