Risk Factors for Descemet Membrane Endothelial Keratoplasty Rejection: Current Perspectives- Systematic Review

Figures & data

Table 1 Review of Literature of DMEK Graft Rejection (Larger Case Series) of the Past 5 Years

S. No	Author, Journal	Article Type	No of Patients	Age, Sex, Visual Acuity,	Risk Factor/ Indication	Clinical Features	Management	Outcomes/ Remarks
1	Basak et al^Citation83 Indian J Ophthalmol 2020 Jun; 68(6): 1044–1053.	Retrospective case series- 600 patients	16 patients	Mean age- 65.7 ± 10.4 years	Iatrogenic, Fuchs Endothelial Corneal Dystrophy, Bullous keratopathy, failed PKP, failed DSEK	Conjunctival hyperemia, corneal edema, KPs at BOC, anterior chamber reaction	Medical management-5, Repeat transplant-13, 7 Repeat DMEK, 5 DSEK/DSAEK, 3 PKP	Clear graft in all cases post-intervention, primary graft-3 failure, secondary graft failure- 6, Endothelial rejection-7
2	Fu and Hollick,^Citation86 Eye (Lond) 2022 Dec 15.	Case series-125 patients	176 eyes	-	Trauma. Fuchs Endothelial Corneal Dystrophy, Bullous keratopathy	Conjunctival congestion, corneal edema, and AC reaction	High-dose topical steroids	Graft failure- 9 (5.1%) eyes: 3 primary graft failure, 2 had an early failure (<3 months), 2 had late failure (<12 months), and 2 grafts did not fully unfold intraoperatively.
3	Maier et al^Citation87 Graefes Arch Clin Exp Ophthalmol, 2022 Aug 30.	Retrospective case series- 150 patients	150 eyes	Mean age 71.7 ± 13.3 years, Mean preoperative visual acuity 1.09 ± 0.59 LogMAR	Secondary glaucoma	Conjunctival congestion, corneal edema, and AC reaction	Topical steroids and repeat grafting	Graft rejection incidence is 2.4% at 1 year and 9.2% at 3 years, Graft failure incidence is 5.5% at 1 year and 16.6% at 3 years
4	Jung et al^Citation88 PLoS One 2022 Jun 30;17(6):e0270037.	Retrospective case series- 32 patients	32 patients	Mean age 64.5±11.1, mean preoperative LogMAR visual acuity 0.92±0.4	Fuch’s endothelial corneal dystrophy, Pseudophakic Bullous keratopathy	Conjunctival congestion, corneal edema, and AC reaction	Topical steroids and repeat grafting	4 patients with immunological failure, 2 patients with primary graft rejection
5	Sorkin et al^Citation89 Cornea 2022 Mar 18	Retrospective analysis- 37 patients	42 eyes, Manual DMEK	-	Fuch’s endothelial corneal dystrophy, Pseudophakic Bullous keratopathy	Conjunctival congestion, corneal edema, and AC reaction	High-dose topical steroids	Primary graft failure-9.5%, Secondary graft failure-0%, graft rejection-7.1%
6	Basak et al^Citation38 Cornea, 2021 Nov 4.	Retrospective analysis- 78 patients	80 eyes	Mean donor age 83.6 ± 3.7 years (range: 80–100 years), mean recipient age 67.2 ± 6.9 years (range: 60–89 years), the preoperative value of 1.36 ± 0.67	Old age, low endothelial cell count	Conjunctival congestion, corneal edema, and AC reaction	Topical steroids	Graft failure 2 eyes at 1 year, graft rejection 2 eyes, 1 reversed by medical management
7	Besek et al^Citation12 Int Ophthalmol, 2022 Jan;42(1):269–279	Retrospective analysis	150 eyes		Fuch’s Corneal Endothelial Dystrophy, Bullous keratopathy			The primary graft failure rate was 11.3%, Secondary graft failure rate was 9.3%, and the allograft rejection rate was 4.7%.
8	Hayashi et al^Citation91 Cornea 2021 Jun 1;40(6):685–689	Retrospective analysis of 24 patients	24 eyes	Mean age- 65.0 years	Failed Optical Penetrating Keratoplasty, vascularized corneas	Corneal edema, superficial vascularization, KPs at BOC,		Graft rejection 1 eye, no episode of primary graft failure
9	Castaner et al^Citation43 J Fr Ophtalmol, 2020 Dec;43(10):e389-e391.	Case Report	1 patient	83-year male	Anterior synechiae, old age	Corneal edema, KPs at the back of the cornea, anterior chamber cells, KPs at BOC	Topical dexamethasone 1 mg/mL 6 times per day	Clear Cornea at 2 months with no signs of rejection
10	Boutin et al^Citation29 Eur J Ophthalmol, 2021 Jul;31(4):2121–2126.	Retrospective case series- 27 patients	27 eyes	Mean age 70.0 ± 13.0 years (range 48–85 years), Preoperative mean LogMAR visual acuity 1.58 ± 0.62	Prior trabeculectomy and/or GDD implantation	Persistent corneal edema	Topical steroids and repeat DMEK	Primary graft failure-1 (3.7%), secondary graft failure 3 (10.3%) eyes, repeat graft failure-1, immunological graft rejection-5 patients
11	Santaella et al^Citation30 Cornea 2020 Nov;39(11):1389–1393.	Retrospective case series- 9 patients	9 eyes	Mean age 51.0 ± 8.6 years, Mean visual acuity 1.28 ± 0.47	Aniridia, Aphakia	Persistent corneal edema, KP at the back of the cornea, anterior chamber reaction	Topical steroids, Penetrating keratoplasty in 2, repeat DMEK in 3, and DSEK in 1, and observation because of poor vision potential	The overall failure rate was 88% (8 of 9 eyes), Primary graft failure was seen in 4 eyes (44%); secondary failure occurred in 4 eyes
12	Sorkin et al^Citation28 Am J Ophthalmol, 2020 Oct;218:7–16.	Retrospective case series- 91 patients	94 eyes, Study group 51 eyes, control group 43 eyes	Study group- Mean age 68 ± 16.1 years (range 26–94 years), Control group-68.9 ± 9.2 years (range 48–89 years)	Pseudophakic bullous keratopathy-25 eyes failed Descemet stripping endothelial keratoplasty (DSAEK; 12 eyes), failed penetrating keratoplasty (10 eyes), Fuchs endothelial corneal dystrophy-3 eyes, and iridocorneal endothelial syndrome-1 eye	Persistent corneal edema, KP at the back of the cornea, anterior chamber reaction	Topical steroids, All primary graft failures cases were managed with repeat surgery, 5 with repeat DMEK, 1 with penetrating keratoplasty, and 1 with DSAEK	Rejection rates in the study group was 19.6%, and in the control group, it was 2.3%, Primary graft failure- 8 eyes (15.7%). Secondary graft failure in 24 eyes (47.1%),
13	Vasiliauskaite et al^Citation18 Am J Ophthalmol, 2020 Sep;217:114–120	Retrospective case series- 88 patients	100 eyes	Mean age 68 ± 12 years at 10 years, 96% of the eyes had BCVA >20/40	Fuchs endothelial corneal Dystrophy-94 eyes, Pseudophakic bullous keratopathy 2 eyes. Failed PKP/DSEK 4 eyes	Persistent corneal edema, KP at the back of the cornea, anterior chamber reaction	High-dose topical steroids and 19 eyes underwent repeat transplantation	Overall graft survival probability was 0.83 at 5 years and 0.79 at 10 years after DMEK, Allograft rejection-4, Primary graft failure-0, Secondary graft failure-6
14	Moura-Coelho et al^Citation74 Am J Ophthalmol, 2020 Jul;215:49–55.	Retrospective case series	189 eyes, 14 re-DMEK eyes, Control group 18 eyes	Mean age 68.4 ±9.0 Mean visual acuity 0.55 (0.42) LogMAR re-DMEK group,	Fuchs endothelial corneal dystrophy, Pseudophakic bullous keratopathy	Persistent corneal edema, KP at the back of Cornea, anterior chamber reaction	High-dose topical steroids	Of the 9 re-DMEK grafts, one graft failed at 8 months. Mean final; final BCVA was 0.09
15	Mednick et al^Citation92 2020 Apr;39(4):457–460.	Retrospective case series-14 patients	15 eyes	Mean donor age was 66.1± 5.5 years Mean BCVA preoperatively 1.7 ± 0.77	Pseudophakic bullous keratopathy-6 failed DSAEK-3, failed DMEK-1 and failed penetrating keratoplasty 1	Persistent corneal edema, KP at the back of Cornea, anterior chamber reaction		1 graft rejection at 7 months postoperatively, the patient developed streptococcal keratitis, Mean final BCVA at 6 months 0.95 ± 0.74
16	Sorkin et al^Citation93 Am J Ophthalmol, 2020 Jun;214:1–8.	Retrospective case series-39 patients	10 eyes of 10 Femto-DMEK patients, 29 eyes of 29 patients in Manual- DMEK patients	Mean donor age was 66.1± 5.5 years Mean BCVA preoperatively 1.7 ± 0.77	Pseudophakic bullous keratopathy-6 failed DSAEK-3, failed DMEK-1, and failed penetrating keratoplasty 1	Persistent corneal edema, KP at the back of Cornea, anterior chamber reaction	High dose topical steroids, Repeat DMEK 4 eyes in M-DMEK group, repeat PK in 3 eyes, and Observation 1 eye	Primary graft failure- 8/29 eyes in the M-DMEK group and 0/10 eyes in the F-DMEK group, Graft rejection 1/10 in the F-DMEK group and 2/29 eyes in the M-DMEK group, Secondary graft failure 0/10 in F-DMEK and 2/29 in M-DMEK group.
17	Birbal et al^Citation17 Cornea 2020 Mar;39(3):290–297.	Retrospective case series-393 patients	500 eyes	Visual acuity preoperatively <20/40–59.9%, ≥ 20/40 −40.1%, ≥ 20/25–8%, ≥ 20/20 1.3%, ≥ 20/17– 0%	Fuchs endothelial corneal dystrophy- 446 eyes, Bullous keratopathy (pseudophakic, aphakic, and phakic IOLs) in 32 eyes, Failed PKP/DSEK/DSAEK/PLK in 16 eyes, Other indications (corneal dystrophies, BK due to congenital glaucoma, and corneal decompensation due to trauma)- 6 eyes	Persistent corneal edema, KP at the back of Cornea, anterior chamber reaction	High-dose topical steroids, repeat DMEK- 4 (0.8%) eyes.	Visual acuity at 5 year follow up <20/40–1.4%, ≥ 20/40 −98.6%, ≥ 20/25–82.4%, ≥ 20/20–53.6%, ≥ 20/17– 15.5% Allograft rejection episode occurred in 14 (2.8%) patients Primary graft failure- in 1 (0.2%) eyes and secondary graft failure in 14 (2.8%) eyes
18	Lifshitz et al^Citation76 Cornea 2019 Sep;38(9):1077–1082	Retrospective case series- 24 patients	28 eyes	Mean age 67 ±16, Mean preoperative LogMAR visual acuity1.53 ± 1.11	Fuchs endothelial corneal dystrophy 6 (21%), PBK 3 (11%), Keratoconus 6 (21%), Corneal infection 4 (14%), Trauma 4 (14%) Chemical burn 1 (4%) Central RK scar 1 (4%) Unknown 3 (11%), previous glaucoma surgery-4 eyes, previous rejection episodes-7 eyes	Persistent corneal edema, KP at the back of Cornea, anterior chamber reaction	High-dose topical steroids	Mean postoperative LogMAR visual acuity at 6 months 0.50 ± 0.46 LogMAR, Graft rejection 6 eyes, Cumulative probability of rejection at 24 months was 21% in DMEK group, Graft failure- 12 eyes (43%)
19	Woo et al^Citation94 Am J Ophthalmol, 2019 Nov;207:288–303.	Retrospective comparative cohort study	121 DMEK eyes	The overall mean age was 67.3 ±11.6 year Mean age of the DMEK group was 65.5 ± 11.8	Fuchs corneal endothelial dystrophy, Bullous keratopathy	Persistent corneal edema, KP at the back of Cornea, anterior chamber reaction	High dose topical and oral steroids	Graft rejection 2 patients in the DMEK group, Clear graft, at last follow-up, BCVA of 20/25 or better in 42.9% of eyes
20	Birbal et al^Citation95 Am J Ophthalmol, 2019 Mar;199:150–158	Retrospective multicentric study	23 DMEK	Mean age of 63.8 ±12.7; age range 37–83 years, Median BCVA preoperatively 1.30 (IQR [2.00–0.82]), Snellen’s equivalent 20/400	Glaucoma drainage device, bullous keratopathy (52%), failed previous transplant (39%), or Fuchs endothelial corneal dystrophy (9%)	Persistent corneal edema, KP at the back of Cornea, anterior chamber reaction	High dose topical steroids, Repeat DMEK 2 cases	Allograft rejection in 2 cases at 7 months, Secondary graft failure in 2/23 cases, Mean postoperative LogMAR VA 0.60 (IQR [1.30–0.40]) at 1 year, 20/80 at 1 year
21	Showail et al^Citation96 Can J Ophthalmol, 2018 Oct;53(5):510–517.	Retrospective case series	250 eyes	The median age of patients- was 72.0 [62.0, 78.0] years, and the Median age of donors was 66.0 [63.0, 71.0] years, Median BCVA- 0.6 [0.4, 1.3] LogMAR (Snellen equivalent, 20/80) preoperatively	FECD-174 eyes (69.6%), Pseudophakic bullous keratopathy 36 eyes (14.4%), Failed PKP-15 eyes (6.0%), Failed DSAEK 13 eyes (5.2%), and Others 12 eyes (4.8%)	Persistent corneal edema, KP at the back of Cornea, anterior chamber reaction	High dose topical steroids, Repeat DMEK 13 cases, 1 repeat DSAEK, 1 repeat PKP	Median BCVA 0.3 [0.2, 0.5] LogMAR (Snellen equivalent, 20/40) at 6 months, 15 had primary graft failure,
22	Pasari et al^Citation97 Cornea 2019 Feb;38(2):151–156.	Retrospective case series- 77 patients	84 eyes- 93 DMEK		FECD-36, Keratoconus-27, Pseudophakic corneal edema-5, Corneal scar-6 Herpetic-5 Endothelial failure-1, previous DSEK, or failed PK-84	Persistent corneal edema, KP at the back of Cornea, anterior chamber reaction	High dose topical steroids	Immunological rejection 2 eyes, 15 months, and 44 months
23	Fajgenbaum et al^Citation98 Eye (Lond), 2018 Oct;32(10):1629–1635.	Retrospective case series-87 eyes	93 DMEK	Mean patient age- 70 ± 11 years (range: 39–93 years)	FECD-79 (90%) eyes, pseudophakic bullous keratopathy −2(2%) eyes, herpes virus endotheliitis- 2 (2% ) eyes, and other causes- 5 (5%) eyes	Persistent corneal edema, KP at the back of Cornea, anterior chamber reaction	Hourly dexamethasone 0.1% drops administered for 1–2 weeks	Graft rejection-3 eyes (3%), 67% (48/72) achieved ≥6/6, 86% (62/72) achieved ≥6/9, and 88% (63/72) achieved ≥6/12.
24	Weller et al^Citation99 Int Ophthalmol. 2022; 42(6): 1789–1798	Retrospective case series-450 eyes	66 DMEK included	Mean age 63 ± 9 years.	FECD 60 eyes (91%), DMEK after failed DSAEK in 4 eyes (6%), and DMEK after failed DMEK in 2 eyes (3%).	Corneal edema, KPs at the back of the cornea, and cellular reaction in the anterior chamber	Hourly topical steroids	Graft failure −4 eyes after year 8. These 4 eyes required repeat DMEK after 101–127 months.
25	Schrittenlocher et al^Citation100 Am J Ophthalmol 2018 Jun;190:171–178.	Retrospective case series of 1340 DMEK	924 DMEK included	Mean age 69.84 ± 10.97 years	Pseudophakic DMEK 707 eyes (52.8%), triple DMEK 552 (41.2%), and 81 (6.0%) phakic DMEK	Corneal edema, KPs at the back of the cornea, and cellular reaction in the anterior chamber	Hourly topical steroids	Graft rejection 18 eyes (1.34%), PGF-4 eyes (0.36%), Repeat DMEK 2 eyes

Table 2 Review of Literature of DMEK Graft Rejection (Case Reports) of the Past 5 Years

S. No	Author, Journal	Article Type	No of Patients	Age, Sex, Visual Acuity	Risk Factor/ Indication	Clinical Features	Management	Outcomes/ Remarks
1	Miyoshi et al^Citation13 Case Rep Ophthalmol 2022 Jan 31;13(1):17–22	Case report	1	66 years, female, 20/125 at 2 months,	Peripheral anterior synechiae	Corneal edema Descemet’s membrane folds, mutton fat keratic precipitates (KPs), and anterior chamber cells	Subconjunctival injection of dexamethasone 3 times once every 2–3 days and betamethasone topically 6 times a day.	BCVA 20/20 2 weeks after the occurrence of the rejection
2	Forshaw et al^Citation46 Int Med Case Rep J, 2022 Apr 14;15:201–204.	Case Report	1	94 years, female, LogMAR visual acuity 0.2 in the right eye and 0.3 in the left eye	BNT162b2 mRNA COVID-19 Vaccine (Pfizer-BioNTech). Fuch’s Endothelial Corneal Dystrophy	DM folds, Anterior chamber reaction	Dexamethasone/tobramycin 6 times a day and with hypertonic saline four times a day in both eyes. Repeat DSEK later	Visual acuity of 0.5 in the right eye and 0.63 in the left eye, with a relatively clear Cornea
3	Bitton et al^Citation47 Am J Ophthalmol Case Rep, 2021 Sep;23:101,138.	Case Report	1	60 years female, 20/32 in the right eye	COVID-19 infection, Fuch’s Corneal Endothelial Dystrophy	Mild conjunctival hyperemia, granulomatous KPs at the back of the Cornea, Anterior Chamber cells	IV Methylprednisolone 500mg/day for 3 days, topical 0.1% dexamethasone hourly, 4 mg/mL subconjunctival dexamethasone injection	Final visual acuity of 20/40 with clear Cornea at
4	Moriyama et al^Citation48 Cornea. 2022 Feb 1;41(2):e1.	Case series- 2 patients	2 patients	Patient 1–77 years, female, 20/40 Patient 2–69, year female, 20/200 in RE and 20/50 in LE	Both patient’s COVID-19 infection, Fuch’s Corneal Endothelial Dystrophy	Patient 1- Hyperemia, corneal edema, keratic precipitates, Patient 2 Persistent corneal edema in LE	1% prednisolone frequent dosing, Frequent topical steroids, Repeat DMEK later	Final visual acuity 20/40, clear Cornea Clear Cornea
5	Phylactou et al^Citation9 Br J Ophthalmol, 2021 Jul;105(7):893–896.	Case series	2 patients	Patient 1–66 years, female, 6/6 Patient 2–83-year-old, female, 6/6	Both patients- SARS-CoV-2 messenger RNA (mRNA) vaccine BNT162b2, Fuch’s Corneal Endothelial Dystrophy	Patient 1-moderate conjunctival injection, diffuse corneal edema, fine KP’s at the back of Cornea inferiorly, anterior chamber (AC) inflammation (cells +1, no flare) Patient 2- bilateral circumcorneal injection, KPs on the endothelium, AC inflammation	Patients 1 and 2-Hourly topical dexamethasone	Patients 1 and 2- Clear graft after 7 days of treatment, 6/6 visual acuity post-treatment
6	Shah et al^Citation82 Cornea 2022 Jan 1;41(1):121–124.	Case series- 4 cases	1 patient	74-years, male	mRNA-1273 vaccination for coronavirus 2 (SARS-CoV-2)	Conjunctival injection, corneal edema, KPs at the Cornea, endothelial rejection line	Topical prednisolone acetate 1% eye drops every 2 h	Clear cornea post-treatment
7	Crnej et al^Citation84 J Fr Ophtalmol, 2021 Oct;44(8):e445-e447.	Case report	1 patient	71 years male	BNT162b2 COVID-19 vaccination	Diffuse ciliary congestion, corneal edema, DM folds, KPs at BOC, AC cells	Topical dexamethasone sodium phosphate 1 mg/mL and oral tablet valacyclovir 1000 mg three times daily	Clear cornea post-treatment
8	Baldis et al^Citation85 Eur J Ophhalmol 2021 Nov 26;11,206,721,211,064,033	Case series- 4 patients	1 patient	77 years female	mRNA-1273	Conjunctival congestion, corneal edema, and AC reaction	Topical dexamethasone every 2 hourly, hypertonic saline every 2 hourly, and subconjunctival dexamethasone	Clear cornea post-treatment
9	Mittal et al^Citation90 Cornea 2021 Aug 1;40(8):972–976.	Retrospective analysis of 2 patients	3 eyes	Patient 1–10-year-old girl, Patient 2–22-year-old male, mean LogMAR visual acuity at baseline 0.15 ± 0.08 (baseline)	Congenital Hereditary Endothelial Dystrophy	1 eye had graft rejection after 7 months, corneal edema, KPs at BOC,	Topical steroids	Mean final visual acuity was 0.33 ± 0.19 at 3 months

Figure 1 Depicting the CONSORT flowchart of the systematic review.

Figure 2 (A) Digital slit lamp image depicting a patient with pseudophakic bullous keratopathy planned for DMEK (B) Digital slit lamp image of a patient with Fuch’ Endothelial Corneal Dystrophy planned for DMEK (C) and (D) Digital slit lamp images of patients post-DMEK depicting a well opposed lenticule with relatively clear cornea.

Figure 3 (A) Digital slit lamp image of a patient post DMEK, depicting stromal edema in the inferior one-third of cornea suggestive of early graft rejection.(B) Digital slit lamp image of a patient on a postoperative day 1, post-DMEK, depicting corneal haze with stromal edema suggestive of primary graft failure. (C) Digital slit lamp image of a patient on postoperative one month, post DMEK, depicting conjunctival congestion, corneal haze with stromal edema suggestive of primary graft failure. (D) Digital slit lamp image of a patient post DMEK following rebubbling, depicting clear cornea, well opposed lenticule with an air bubble occupying 1/3rd anterior chamber.

Basak SK, Basak S, Gajendragadkar N, Ghatak M. Overall clinical outcomes of Descemet membrane endothelial keratoplasty in 600 consecutive eyes: a large retrospective case series. Indian J Ophthalmol. 2020;68(6):1044–1053. doi:10.4103/ijo.IJO_1563_19

 PubMed Web of Science ®Google Scholar

Fu L, Hollick EJ. Rebubbling and graft detachment in Descemet membrane endothelial keratoplasty using a standardised protocol. Eye. 2022. doi:10.1038/s41433-022-02362-2

 Web of Science ®Google Scholar

Maier AB, Pilger D, Gundlach E, Winterhalter S, Torun N, Dietrich-Ntoukas T. Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma. Graefes Arch Clin Exp Ophthalmol. 2022;30:1.

 Google Scholar

Jung YH, Yoon CH, Kim MK. Clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) with imported donor corneas in eyes of Asian patients; endothelium-in versus endothelium-out method. PLoS One. 2022;17(6):e0270037. doi:10.1371/journal.pone.0270037

 PubMed Web of Science ®Google Scholar

Sorkin N, Gouvea L, Din N, et al. Five-year safety and efficacy of femtosecond laser-assisted descemet membrane endothelial keratoplasty. Cornea. 2022. doi:10.1097/ICO.0000000000003019

 Web of Science ®Google Scholar

Basak SK, Basak S, Gajendragadkar N. Outcomes of descemet membrane endothelial keratoplasty using cornea from elderly donors aged 80 years and older: in the aftermath of current donor shortage. Cornea. 2021;41:1437–1443. doi:10.1097/ICO.0000000000002902

 PubMed Web of Science ®Google Scholar

Beşek NK, Yalçınkaya G, Kırgız A, et al. Graft survival and clinical outcomes of Descemet membrane endothelial keratoplasty: long-term results. Int Ophthalmol. 2022;42(1):269–279. doi:10.1007/s10792-021-02078-4

 PubMed Web of Science ®Google Scholar

Hayashi T, Zhang W, Hos D, et al. Descemet membrane endothelial keratoplasty in vascularized eyes: outcome and effect on corneal neovascularization. Cornea. 2021;40(6):685–689. doi:10.1097/ICO.0000000000002502

 PubMed Web of Science ®Google Scholar

Carreras-Castañer X, Batlle-Ferrando S, Marin-Martinez S, Miguel L, Feu-Basilio S, Peraza-Nieves JE. Anterior synechiae related to an incipient Descemet’s membrane endothelial keratoplasty (DMEK) allograft rejection. J Fr Ophtalmol. 2020;43(10):e389–e391. doi:10.1016/j.jfo.2020.01.033

 PubMed Web of Science ®Google Scholar

Boutin T, Sorkin N, Einan-Lifshitz A, et al. Descemet membrane endothelial keratoplasty in patients with prior glaucoma surgery. Eur J Ophthalmol. 2021;31(4):2121–2126. doi:10.1177/1120672120936178

 PubMed Web of Science ®Google Scholar

Santaella G, Sorkin N, Mimouni M, et al. Outcomes of descemet membrane endothelial keratoplasty in aphakic and aniridic patients. Cornea. 2020;39(11):1389–1393. doi:10.1097/ICO.0000000000002387

 PubMed Web of Science ®Google Scholar

Sorkin N, Mimouni M, Kisilevsky E, et al. Four-year survival of descemet membrane endothelial keratoplasty in patients with previous glaucoma surgery. Am J Ophthalmol. 2020;218:7–16. doi:10.1016/j.ajo.2020.05.020

 PubMed Web of Science ®Google Scholar

Vasiliauskaitė I, Oellerich S, Ham L, et al. Descemet membrane endothelial keratoplasty: ten-year graft survival and clinical outcomes. Am J Ophthalmol. 2020;217:114–120. doi:10.1016/j.ajo.2020.04.005

 PubMed Web of Science ®Google Scholar

Moura-Coelho N, Manero F, Elies D, et al. Repeat descemet membrane endothelial keratoplasty for failed primary descemet membrane endothelial keratoplasty at a referral center for keratoplasty in Spain: DIMOEK study. Am J Ophthalmol. 2020;215:49–55. doi:10.1016/j.ajo.2020.03.015

 PubMed Web of Science ®Google Scholar

Mednick Z, Sorkin N, Einan-Lifshitz A, et al. Long-term outcomes of descemet membrane endothelial keratoplasty in post vitrectomized eyes with the use of pars plana infusion. Cornea. 2020;39(4):457–460. doi:10.1097/ICO.0000000000002228

 PubMed Web of Science ®Google Scholar

Sorkin N, Mimouni M, Santaella G, et al. Comparison of manual and femtosecond laser-assisted descemet membrane endothelial keratoplasty for failed penetrating keratoplasty. Am J Ophthalmol. 2020;214:1–8. doi:10.1016/j.ajo.2019.11.015

 PubMed Web of Science ®Google Scholar

Birbal RS, Ni Dhubhghaill S, Bourgonje VJA, et al. Five-year graft survival and clinical outcomes of 500 consecutive cases after descemet membrane endothelial keratoplasty. Cornea. 2020;39(3):290–297. doi:10.1097/ICO.0000000000002120

 PubMed Web of Science ®Google Scholar

Einan-Lifshitz A, Mednick Z, Belkin A, et al. Comparison of descemet stripping automated endothelial keratoplasty and descemet membrane endothelial keratoplasty in the treatment of failed penetrating keratoplasty. Cornea. 2019;38(9):1077–1082. doi:10.1097/ICO.0000000000001993

 PubMed Web of Science ®Google Scholar

Woo JH, Ang M, Htoon HM, Tan D. Descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty and penetrating keratoplasty. Am J Ophthalmol. 2019;207:288–303. doi:10.1016/j.ajo.2019.06.012

 PubMed Web of Science ®Google Scholar

Birbal RS, Tong CM, Dapena I, et al. Clinical outcomes of descemet membrane endothelial keratoplasty in eyes with a glaucoma drainage device. Am J Ophthalmol. 2019;199:150–158. doi:10.1016/j.ajo.2018.11.014

 PubMed Web of Science ®Google Scholar

Showail M, Obthani MA, Sorkin N, et al. Outcomes of the first 250 eyes of Descemet membrane endothelial keratoplasty: Canadian centre experience. Can J Ophthalmol. 2018;53(5):510–517. doi:10.1016/j.jcjo.2017.11.017

 PubMed Web of Science ®Google Scholar

Pasari A, Price MO, Feng MT, Price FW Jr. Descemet membrane endothelial keratoplasty for failed penetrating keratoplasty: visual outcomes and graft survival. Cornea. 2019;38(2):151–156. doi:10.1097/ICO.0000000000001763

 PubMed Web of Science ®Google Scholar

Fajgenbaum MAP, Kopsachilis N, Hollick EJ. Descemet’s membrane endothelial keratoplasty: surgical outcomes and endothelial cell count modelling from a UK centre. Eye. 2018;32(10):1629–1635. doi:10.1038/s41433-018-0152-x

 PubMed Web of Science ®Google Scholar

Weller JM, Kruse FE, Tourtas T. Descemet membrane endothelial keratoplasty: analysis of clinical outcomes of patients with 8–10 years follow-up. Int Ophthalmol. 2022;42(6):1789–1798. doi:10.1007/s10792-021-02176-3

 PubMed Web of Science ®Google Scholar

Schrittenlocher S, Schaub F, Hos D, Siebelmann S, Cursiefen C, Bachmann B. Evolution of consecutive descemet membrane endothelial keratoplasty outcomes throughout a 5-year period performed by two experienced surgeons. Am J Ophthalmol. 2018;190:171–178. doi:10.1016/j.ajo.2018.03.036

 PubMed Web of Science ®Google Scholar

Miyoshi Y, Ono T, Seki S, et al. Corneal graft rejection after descemet’s membrane endothelial keratoplasty with peripheral anterior synechiae. Case Rep Ophthalmol. 2022;13(1):17–22. doi:10.1159/000520877

 PubMed Web of Science ®Google Scholar

Forshaw TRJ, Jørgensen C, Kyhn MC, Cabrerizo J. Acute bilateral descemet membrane endothelial keratoplasty graft rejection after the BNT162b2 mRNA COVID-19 vaccine. Int Med Case Rep J. 2022;15:201–204. doi:10.2147/IMCRJ.S362698

 PubMed Web of Science ®Google Scholar

Bitton K, Dubois M, Courtin R, Panthier C, Gatinel D. Descemet’s membrane endothelial keratoplasty (DMEK) rejection following COVID-19 infection: a case report. Am J Ophthalmol Case Rep. 2021;23:101138. doi:10.1016/j.ajoc.2021.101138

 PubMedGoogle Scholar

Moriyama AS, Campos MSQ. Presumed DMEK graft rejection associated with COVID-19 infection. Cornea. 2022;41(2):e1. doi:10.1097/ICO.0000000000002882

 PubMed Web of Science ®Google Scholar

Phylactou M, Li JO, Larkin DFP. Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine. Br J Ophthalmol. 2021;105(7):893–896. doi:10.1136/bjophthalmol-2021-319338

 PubMed Web of Science ®Google Scholar

Shah AP, Dzhaber D, Kenyon KR, Riaz KM, Ouano DP, Koo EH. Acute Corneal Transplant Rejection After COVID-19 Vaccination. Cornea. 2022;41(1):121–124. doi:10.1097/ICO.0000000000002878

 PubMed Web of Science ®Google Scholar

Crnej A, Khoueir Z, Cherfan G, Saad A. Acute corneal endothelial graft rejection following COVID-19 vaccination. J Fr Ophtalmol. 2021;44(8):e445–e447. doi:10.1016/j.jfo.2021.06.001

 PubMed Web of Science ®Google Scholar

Balidis M, Mikropoulos D, Gatzioufas Z, de Politis PB, Sidiropoulos G, Vassiliadis V. Acute corneal graft rejection after anti-severe acute respiratory syndrome-coronavirus-2 vaccination: a report of four cases. Eur J Ophthalmol. 2021;2021:11206721211064033.

 Google Scholar

Mittal V, Sehdev N, Mittal R. Descemet membrane endothelial keratoplasty in congenital hereditary endothelial dystrophy: initial experiences. Cornea. 2021;40(8):972–976. doi:10.1097/ICO.0000000000002701

 PubMed Web of Science ®Google Scholar