Abstract
Purpose: :
To evaluate the association of outcomes between fellow eyes following bilateral Descemet’s stripping endothelial keratoplasty (DSEK).
Methods: :
The records of all patients undergoing DSEK in a cornea referral practice from 2008 to 2011 were reviewed to identify patients who had received DSEK in both eyes. 37 patients who underwent DSEK in both eyes for Fuchs’ dystrophy or pseudophakic bullous keratopathy were identified. All patients had at least six months of follow up after the second procedure. In each patient, both procedures were performed by the same surgeon.
Results: :
74 eyes of 37 patients with either Fuchs’ dystrophy or pseudophakic bullous keratopathy were evaluated. 65/74 (88%) of eyes achieved a postoperative BCVA ≥ 20/50. Of the 9 eyes that did not, two had a prior retinal detachment, two developed cystoid macular edema, one had a suture related infection, and one had postoperative irregular astigmatism. 57/74 (77%) eyes achieved a postoperative BCVA ≥ 20/40 at four months. There was a moderately positive correlation in the postoperative BCVA between fellow eyes (r =0.45). Of the 19 eyes with a BCVA ≥ 20/30 in the first eye, 58% achieved a BCVA ≥ 20/30 in the fellow eye. Conversely, of the 18 eyes with a BCVA ≤ 20/40 in the first eye, 89% achieved a BCVA ≤ 20/40 in the fellow eye (t=2.125; p=0.04). 9/74 (12%) eyes had graft dislocations, 6 of which were successfully re-bubbled in the office. There was no significant correlation in graft dislocation between fellow eyes (r=0.18). 3/9 eyes with graft dislocation required a repeat DSEK. 8/74 (11%) eyes required IOP lowering drops following surgery. 4/8 (50%) eyes were from the same patient. There was a moderately positive correlation in the need for postoperative IOP lowering medications between eyes (r=0.44). 3/9 (33%) eyes with graft dislocations had combined DSEK and cataract surgery, compared to 12/74 (16%) of the entire set. Only 1/74 eyes had an episode of endothelial rejection.
Conclusions: :
There appears to be a moderate association between fellow eyes in postoperative BCVA and the need for IOP lowering drops postoperatively, but not in the incidence of graft dislocation. A high percentage of eyes with poorer outcomes in the first eye had poorer outcomes in the fellow eye. A significantly smaller percentage of eyes with very good outcomes in the first eye had a similar outcome in the fellow eye. There was a higher representation of DSEK triples in the dislocation subgroup compared to the entire population. Further studies are needed to clarify the strength of these associations.
Keywords: cornea: clinical science • transplantation