Purpose To evaluate graft survival and clinical outcomes up to 10 years after Descemet membrane endothelial keratoplasty (DMEK).

Setting/Venue Retrospective cohort study conducted at the Netherlands Institute for Innovative Ocular Surgery.

Methods 750 consecutive DMEK eyes, not including the very first 25 DMEK eyes that constitute the technique learning curve, were included. Main outcome parameters (survival, best-corrected visual acuity (BCVA), central endothelial cell density (ECD)) was evaluated up to 10-years postoperatively and postoperative complications were documented. Outcomes were analyzed for the entire study group and separately for the subgroup of the first 100 DMEK eyes.

Results For the subgroup of 100 DMEK eyes, 82% and 89% reached a BCVA of ≥20/25 (Decimal VA ≥0.8) at 5- and 10 years postoperatively, respectively, and preoperative donor ECD decreased by 59% at 5 years and 68% at 10 years postoperatively. Graft survival probability for the first 100 DMEK eyes was 0.83 [95% Confidence Interval (CI), 0.75-0.92] and 0.79 [95% CI, 0.70 -0.88] at 5- and 10-years postoperatively, respectively. For the total study group, clinical outcome in terms of BCVA and ECD were comparable, but graft survival probability was significantly higher at 5- and 10-year postoperatively.

Conclusions Most eyes operated in the pioneering phase of DMEK showed excellent and stable clinical outcomes with a promising graft longevity over the first decade after surgery. The increase in DMEK experience resulted in a lower graft failure rate and positively affected longer-term graft survival probability.