Corneal Nerve Alterations After Descemet Membrane Endothelial Keratoplasty: An In Vivo Confocal Microscopy Study

Purpose: Recent studies have identified diminishment of corneal nerves as another hallmark of Fuchs endothelial corneal dystrophy. This study aimed to analyze changes in corneal nerves after Descemet membrane endothelial keratoplasty (DMEK). Methods: Twenty-five patients were assessed for nerve alterations preoperatively and 1 week, 4 months, and 20 months after DMEK surgery. Morphology of the central subbasal nerve plexus was quantified by in vivo confocal microscopy. Results: The total nerve length (481.2 +/- 81.9 vs. 1536.0 +/- 123.8 mu m per frame, P < 0.0001), total nerve number (2.2 +/- 0.3 vs. 7.2 +/- 0.5 per frame, P < 0.0001), number of main nerve trunks (1.8 +/- 0.2 vs. 3.5 +/- 0.3 per frame, P < 0.0001), and number of nerve branches (0.5 +/- 0.2 vs. 3.7 +/- 0.4 per frame, P < 0.0001) were significantly decreased 1 week after DMEK compared with preoperative measurements. Ten months postoperatively, corneal nerves recovered to preoperative values. Central corneal sensation significantly reduced postoperatively (5.1 +/- 1.0 vs. 6.0 +/- 0.0, P = 0.001), but recovered during follow-up (10 months: 6.0 +/- 0.0). Conclusions: DMEK diminishes the density and the function of subbasal corneal nerves early after transplantation. However, a complete recovery of corneal nerve density and function up to preoperative values occurs within 4 to 10 months.