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Sanjay V Patel, Katrin Wacker, Jay W McLaren, Leo J Maguire, Keith H Baratz; Descemet stripping endothelial keratoplasty for Fuchs endothelial dystrophy: 5-year results of a prospective study.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3977.
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© ARVO (1962-2015); The Authors (2016-present)
To determine 5-year outcomes of Descemet stripping endothelial keratoplasty (DSEK) for Fuchs endothelial corneal dystrophy (FECD) in a prospective observational study.
Fifty eyes of 42 subjects with FECD (median age, 67 years: range 41- 87 years) were examined before DSEK and through 5 years after DSEK. All eyes were pseudophakic after surgery. Best-corrected visual acuity (BCVA) was measured by the electronic Early Treatment of Diabetic Retinopathy Study protocol, corneal power was measured by manual keratometry, anterior corneal haze was measured by confocal microscopy (ConfoScan 4), and central corneal thickness was measured by ultrasonic pachymetry (DGH 1000). Donor endothelial cell loss from preoperative was determined by digitizing apices (HAI CAS System) of endothelial cells in confocal images. Significances of changes after surgery were determined by using generalized estimating equation models to account for possible correlation between fellow eyes of the same subject. Data reported are for 31 eyes of 26 subjects who completed 5 years of follow-up.
BCVA improved from 0.43 ± 0.21 logMAR (mean ± SD; Snellen equivalent, 20/54) before DSEK to 0.13 ± 0.16 logMAR (20/30) at 1 year (p<0.001), and further improved to 0.07 ± 0.13 logMAR (20/23) at 5 years (p=0.005 vs. 1 year). The proportion of eyes with BCVA better than 20/25 (Snellen equivalent) was 42% at 6 months, 52% at 1 year, and 65% at 5 years. Mean corneal power was 43.4 ± 1.3 D before DSEK and 43.3 ± 1.5 D at 5 years (p=0.33). Anterior corneal haze decreased from 2024 ± 605 scatter units (SU) before DSEK to 1901 ± 688 SU at 1 year (p<0.001), and continued to improve through 5 years (1492 ± 469 SU, p<0.001 vs. 1 year). Total corneal thickness did not change between 1 year (695 ± 54 µm) and 5 years (701 ± 57 µm, p=0.29). Endothelial cell loss at 5 years was 54 ± 15 %. Five grafts failed over the course of the study (included the surgeons’ earliest cases).
BCVA continues to improve between 1 and 5 years after DSEK. At 5 years, two-thirds of eyes see better than 20/25 despite a mean total corneal thickness of 700 µm. Improvement in vision is accompanied by continued reduction in corneal haze after 1 year, suggesting ongoing remodeling of the cornea after endothelial keratoplasty. The known hyperopic shift after DSEK is not explained by a change in power of the anterior corneal surface.
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