Purpose: 

The purpose of this study was to report the outcomes of Descemet membrane endothelial keratoplasty (DMEK) using corneas from elderly donors aged 80 years and older.

Methods: 

Eighty eyes of 78 patients who underwent DMEK-only or DMEK combined with cataract extraction (triple-DMEK) with surgeon-prepared graft between April 2016 and March 2020 were reviewed. Corrected distance visual acuity, endothelial cell density (ECD), and endothelial cell loss after 6 months, 1 year, and 2 years were analyzed.

Results: 

The mean donor age was 83.6 ± 3.7 years (range: 80–100 years), and the mean donor ECD was 2889 ± 177 cells/mm² (range: 2604–3460 cells/mm²). The mean recipient age was 67.2 ± 6.9 years (range: 60–89 years), and the mean follow-up was 21 ± 11 months (range: 6–52 months). The mean corrected distance visual acuity improved from a preoperative value of 1.36 ± 0.67 logarithm of the minimum angle of resolution to 0.22 ± 0.18 at 6 months (n = 75), 0.21 ± 0.2 at 1 year (n = 64), and 0.23 ± 0.3 logarithm of the minimum angle of resolution at 2 years (n = 41), respectively (P < 0.001). In 72 eyes (96%), the graft remained transparent until the last follow-up visit. The mean postoperative ECD was 2073 ±336 (n = 75), 1951 ± 379 (n = 65), and 1807 ± 431 cells/mm² (n = 41) at 6 months, 1 year, and 2 years, respectively. Five eyes (6.7%) had donor detachments of which 4 required rebubbling. Two grafts failed after 1 year, and 2 eyes (2.6%) had graft rejection, of which 1 eye was reverted successfully by medical management.

Conclusions: 

Cornea from elderly donors aged 80 years and older with good selection criteria may be considered for DMEK with successful outcomes. For India and other countries with unmet tissue needs, every best single cornea counts.

中文翻译：

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使用 80 岁及以上老年捐献者角膜进行后弹力层内皮角膜移植术的结果：当前捐献者短缺的后果

目的： 

本研究的目的是报告使用 80 岁及以上老年捐献者的角膜进行后弹力层内皮角膜移植术 (DMEK) 的结果。

方法： 

对 2016 年 4 月至 2020 年 3 月期间仅接受 DMEK 或 DMEK 联合白内障摘除术（三重 DMEK）以及外科医生准备的移植物的 78 名患者的 80 只眼睛进行了回顾。分析 6 个月、1 年和 2 年后的矫正远视力、内皮细胞密度(ECD) 和内皮细胞损失。

结果： 

供体平均年龄为 83.6 ± 3.7 岁（范围：80-100 岁），平均供体 ECD 为 2889 ± 177 个细胞/mm ²（范围：2604-3460 个细胞/mm ²）。接受者的平均年龄为 67.2 ± 6.9 岁（范围：60-89 岁），平均随访时间为 21 ± 11 个月（范围：6-52 个月）。平均矫正远视力从术前最小分辨角对数 1.36 ± 0.67 提高到 6 个月时的 0.22 ± 0.18 (n = 75)、1 年时的 0.21 ± 0.2 (n = 64) 和 0.23 ± 0.23 ±分别为 2 年时最小分辨率角的 0.3 对数 (n = 41) ( P < 0.001)。72 只眼睛 (96%) 的移植物在最后一次随访之前一直保持透明。术后 6 个月、1 年和 2 年的平均 ECD 分别为 2073 ± 336 (n = 75)、1951 ± 379 (n = 65) 和 1807 ± 431 个细胞/mm ^{2 (n = 41)。}五只眼睛 (6.7%) 存在供体脱离，其中 4 只需要重新起泡。1年后，2例移植失败，2只眼（2.6%）出现移植排斥反应，其中1只眼经医疗处理成功恢复。

结论： 

具有良好选择标准的 80 岁及以上老年捐献者的角膜可以考虑进行 DMEK，并取得成功的结果。对于印度和其他组织需求未得到满足的国家来说，每一个最好的角膜都很重要。