Abstract
Purpose: :
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.
Methods: :
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.
Results: :
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)
Conclusions: :
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.
Keywords: cornea: endothelium • cornea: clinical science