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M. A. Terry, N. Shamie, A. K. Shah, D. Davis-Boozer, D. J. Friend; Endothelial Keratoplasty: Graft Survival and Endothelial Cell Loss at 5 Years and Beyond. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1236.
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To determine long term graft survival and donor cell loss in endothelial keratoplasty (EK) surgery and the effect that insertion wound size has on long term endothelial cell loss.
Our original 36 large incision DLEK eyes done between the years of 2000 and 2003 were followed past the 5 year visit to determine graft survival past 5 years. Specular microscopy was performed on small and large DLEK cases that were 5 or more years out from surgery and the total percentage of cell loss was determined and compared.
Over the past 8 years there were 4 patient deaths and 6 other patients lost to follow-up in the large incision series. Of the 26 remaining grafts, 25 remained clear out to 8 years, with one graft replaced due to graft rejection. Mean cell count at 5 years was 1157 +/- 570 (Range = 550 to 2709) for large incision DLEK and 778 +/- 182 (Range = 529 to 1095) for small incision DLEK. (p < .05) Cell loss from pre-op for large 9.0 mm incision DLEK (n=20) was 21%, 26%, and 60% at 1, 2, and 5 years, respectively. Cell loss for small 5.0 mm incision DLEK (n=10) was significantly worse with losses of 34%, 47% and 72% at the same time points. (p<.05 for all time points)
Despite long term low cell counts, most donor tissue remains clear after EK even 8 years after surgery. Donor cell loss in EK surgery falls dramatically between 2 and 5 years, with smaller insertion wound cases worse than larger insertion wound cases.
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