Abstract
Purpose To investigate the long-term anatomical and functional outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK). Methods Prospective follow-up of 114 eyes (95 subjects) after DSAEK for endothelial dysfunction. Measurements included best spectacle-corrected visual acuity (BSCVA), straylight, endothelial cell density (ECD), and graft thickness. Results The mean follow-up time was 5.1 ± 1.5 years. Four grafts ultimately failed (after 5 to 7 years). From baseline up to 1 year after DSAEK, mean BSCVA improved by 0.30 logMAR. This beneficial effect remained until the last follow-up (LFU). After DSAEK, straylight was reduced. ECD sharply dropped by 900 cells/mm2 (33%) immediately after surgery and, thereafter, steadily decreased at a rate of 11 cells/mm2 per month. No significant correlation was observed between graft thickness at 3 years and BSCVA. Conclusions We observed a low graft failure rate and a normalization of graft thickness. Postoperative straylight remained elevated relative to the normal population. The sharp initial and the subsequent more gradual ECD decline are consistent with other studies. A significant and prolonged functional gain can be achieved by posterior lamellar grafting for endothelial dysfunction.
Highlights
Conditions such as Fuchs’ endothelial dystrophy (FED) or pseudophakic bullous keratopathy (PBK) may lead to irreversible corneal edema and, loss of vision
114 pseudophakic eyes (95 patients) that underwent Descemet stripping automated endothelial keratoplasty (DSAEK) were included in this study
As can be expected from the primary indication for DSAEK being the restoration of visual acuity, a significant beneficial effect on best spectacle-corrected visual acuity (BSCVA) was observed
Summary
Conditions such as Fuchs’ endothelial dystrophy (FED) or pseudophakic bullous keratopathy (PBK) may lead to irreversible corneal edema and, loss of vision. Full-thickness corneal surgery like penetrating keratoplasty (PKP) has some disadvantages such as an unpredictable refractive outcome and a susceptibility to trauma. Due to major innovative steps (e.g., [3,4,5]) and further refinement (e.g., [6, 7]), posterior lamellar techniques such as Descemet stripping automated endothelial keratoplasty (DSAEK) have become the mainstay for the surgical treatment of endothelial dysfunction and, thereby, restoration of vision [8,9,10,11]. Endothelial keratoplasty has some obvious advantages, such as small incision surgery (reducing complication rates), sutureless attachment of the donor graft to the recipient cornea (minimizing induced astigmatism), and accelerated visual recovery
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