Endothelial Cell Loss and Graft Survival after Descemet's Stripping Automated Endothelial Keratoplasty and Penetrating Keratoplasty

Abstract

We sought to compare endothelial cell (EC) loss and graft survival after Descemet's stripping automated endothelial keratoplasty (DSAEK) and conventional penetrating keratoplasty (PK) in Asian eyes. Retrospective, nested, cohort study. Consecutive patients who underwent DSAEK or PK with Fuchs' endothelial dystrophy or pseudophakic and aphakic bullous keratopathy (BK) at a single tertiary center from April 1, 2006, to April 1, 2008. Clinical data, and donor and recipient characteristics were recorded from our prospective cohort from the Singapore Corneal Transplant Study. Percent EC loss and graft survival up to 3 years. There were no differences in baseline characteristics of patients comparing DSAEK and PK; there were more patients with BK (n = 141, 68.4%) than Fuchs' dystrophy. Percent EC loss was lower in DSAEK compared with PK at 1 (30 ± 22% vs 37 ± 25%; P = 0.045), 2 (36 ± 23% vs 45 ± 33%; P = 0.018), and 3 years (39 ± 24% vs 47 ± 28%; P = 0.022) postoperatively. Graft survival was comparable (log-rank P = 0.671) between DSAEK and PK at 1 (94% vs 90%), 2 (88% vs 85%), and 3 years (87% vs 85%). Compared with PK, DSAEK resulted in lower EC loss with comparable cumulative graft survival rates for up to 3 years in patients with Fuchs' dystrophy and BK.