Early postoperative corneal thickness and 12‐month endothelial cell outcomes after descemet membrane endothelial keratoplasty: A multicentre analysis

Abstract Purpose To evaluate whether early postoperative corneal thickness is associated with 12‐month endothelial cell and visual outcomes after Descemet membrane endothelial keratoplasty (DMEK). Methods This retrospective multicentre study included eyes with central corneal thickness (CCT) data within 1 month and endothelial cell density (ECD) at 12 months. Early postoperative CCT was defined as the maximum value at 1 week or 1 month. Associations with ECD loss and visual acuity (VA) improvement were analysed using correlation and regression models. Results A total of 208 eyes were included. CCT decreased rapidly within the first postoperative month. Mean ECD decreased from 2690.7 ± 209.5 cells/mm 2 at baseline to 1528.4 ± 494.0 cells/mm 2 at 12 months, corresponding to a mean endothelial cell loss of 43.4%. No significant correlation was observed between early postoperative CCT reduction and 12‐month ECD loss ( r = 0.11, p = 0.075). In multivariable analysis, CCT reduction was not independently associated with ECD loss ( p = 0.308) or VA improvement ( p = 0.977), whereas baseline ECD ( p = 0.039), baseline VA ( p < 0.001) and country ( p < 0.001) remained significant predictors. Conclusions Early postoperative corneal thickness was not associated with endothelial or visual outcomes. These findings suggest that early CCT reflects short‐term corneal recovery but has limited prognostic value after DMEK.