Corneal Characteristics After Small-Diameter DMEK Graft for Fuchs Corneal Dystrophy—Long-Term Observation

<b>Background/Objectives</b>: This study aimed to evaluate long-term postoperative outcomes following the use of small-diameter grafts in Descemet Membrane Endothelial Keratoplasty (DMEK) procedures. <b>Methods</b>: Thirty-four eyes were evaluated after DMEK surgery. Best-corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss (ECL), central corneal thickness (CCT), mean keratometry (MK), mean astigmatism (MA), astigmatism asymmetry (AA), and higher-order aberrations (HOA) were assessed at baseline and 12, 24 and 36 months after surgery using anterior segment swept-source OCT (CASIA2, Tomey, Japan). <b>Results</b>: BCVA gradually improved during the 12-month follow-up, after which the stabilisation of this parameter was documented. Compared with the donor values, the cumulative median ECL reached approximately 63.95% over 36 months. No significant changes in total keratometry between baseline recordings and 36-month data were observed. Total astigmatism power significantly decreased between baseline and the 12th month and subsequently between the 12th and 24th month, with consecutive stabilisation of astigmatism power from the 24th month to the 36th month of follow-up. Significant reductions in HOA were observed until the 12th month, followed by the stabilisation of these parameters. <b>Conclusions</b>: The use of smaller grafts in DMEK demonstrates high effectiveness in maintaining high visual and refractive quality while offering potential advantages in tissues.