Graft rejection and failure following endothelial keratoplasty (DSAEK) and penetrating keratoplasty for secondary endothelial failure.

Abstract

To compare the frequency of rejection and graft failure after Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) for secondary endothelial failure. Seventy-eight eyes undergoing DSAEK from 2006 to 2013 and 80 eyes undergoing PK from 1998 to 2013 were included. Indications were endothelial failure due to pseudophakic bullous keratopathy (82%), previous eye trauma (8%), uveitis (4%) or other causes (6%). Rejection episodes and graft failure were recorded, together with preoperative risk factors (glaucoma, neovascularization and active inflammation). Kaplan-Meier survival curves with up to 4 years follow-up were used to compare DSAEK with PK, as well as low-risk with high-risk eyes. During follow-up, 15% of the PK-treated eyes and 4% of the DSAEK-treated eyes experienced rejection. Graft failure occurred in 8% of the PK-treated eyes and in 7% of the DSAEK-treated eyes. No significant differences were found in the rate of rejection (p=0.11), graft failure (p=0.29) or rejection-related graft failure (p=0.30) between DSAEK and PK in low-risk eyes. In DSAEK, high-risk eyes (mainly with glaucoma) experienced significantly more rejection episodes (p=0.01), graft failures (p=0.04) and rejection-related graft failures (p=0.04) compared with low-risk eyes. No differences were seen between high-risk and low-risk PK-treated eyes (p>0.40). In the present, relatively small study, no differences in rejection rate or graft failure were found between DSAEK and PK in low-risk eyes. However, glaucoma seems to increase the risk of graft complications after DSAEK for secondary endothelial failure. Long-term studies of larger samples sizes are needed to confirm this.