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Chirag R. Patel, David C. Ritterband, Faye Knoll, Elaine Wu, John A. Seedor, Richard S. Koplin; Long-Term Graft Survival Rates in Descemet’s Stripping Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2012;53(14):48.
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To determine the long-term survival rates of corneal grafts after Descemet stripping automated endothelial keratoplasty (DSAEK).
A retrospective chart review of all patients that underwent DSAEK by two experienced corneal surgeons at the New York Eye and Ear Infirmary over a 2.5-year period from July 1, 2006 through December 31, 2008. Only patients with a minimum of 36 months of follow-up were included in the study. Patients that developed primary graft failure following surgery, defined as failure of the graft to clear at any point post-operatively, were excluded.
67 eyes of 65 patients were found to meet the inclusion criteria. 56.9% of the patients were female and mean age at time of procedure was 69.4 years (range 33-89 years). Indications for DSAEK included: Fuch’s dystrophy (40.3%), pseudophakic bullous keratopathy (26.9%), previously failed DSAEK (14.9%), corneal endothelial failure from other causes (11.9%), previous failed penetrating keratoplasty (3.0%), aphakic bullous keratopathy (1.5%), and trauma (1.5%). The overall 3-year graft survival rate was 80.6% (n=54). The survival rate was highest in Fuch’s dystrophy (96.3%), decreasing to 77.8% in pseudophakic bullous keratopathy, and lowest (37.5%) in those with endothelial failure from anterior chamber hardware (e.g. glaucoma drainage devices) or disorganized anterior segments. Eyes with pre-existing glaucoma had a significantly higher risk of failure with a survival rate of 61.9% compared to 91.1% in eyes without glaucoma (p < 0.05).
Three-year survival rates of DSAEK grafts are similar in this series to previously published results with the lowest rate of failure in eyes with Fuch’s dystrophy compared to those with other causes of endothelial dysfunction. Eyes with glaucoma were at significantly higher risk for graft failure following DSAEK.
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