134 - Outcomes of Descemet Stripping Automated Endothelial Keratoplasty

Abstract

Endothelial keratoplasty (EK) has become the standard of care for the surgical treatment of corneal endothelial dysfunction. Compared with traditional penetrating keratoplasty (PK), EK has demonstrated superior outcomes with regard to recovery time, final visual acuity, corneal astigmatism, and globe stability. Complications of Descemet stripping automated endothelial keratoplasty (DSAEK) are most directly related to surgeon experience and technique; however, hypotony and a history of diabetes in the donor graft have been independently associated with graft dislocation and primary graft failure, respectively. Use of “ultrathin” (<130 μm) or “nanothin” (<50 μm) donor tissue may lead to improved best spectacle-corrected visual acuity (BSCVA) compared with thicker grafts. The DSAEK procedure induces very little astigmatism as the anterior corneal power remains stable, though changes in posterior corneal curvature lead to an overall hyperopic shift in refraction. Donor endothelial cell loss occurs more rapidly in the early months following DSAEK but reaches a plateau between 6 months and 2 years postprocedure; at 5 years endothelial survival in DSAEK grafts compares favorably to that of PK.