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D. S. Slade, M. D. Mifflin, L. Taylor; Post-DSEK Endothelial Cell Loss Does Not Predict Final BCVA. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2214.
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© ARVO (1962-2015); The Authors (2016-present)
Endothelial cell count and best-corrected visual acuity (BCVA) following Descemet’s stripping endothelial keratoplasty (DSEK) are common measures used to determine success after surgery. Herein, we compare these two outcome measures to evaluate the relationship of endothelial cell losses following DSEK and final BCVA.
A retrospective review of 12 patient charts (total of 14 eyes) receiving DSEK between June 2006 and April 2008 was undertaken to retrieve pre-op BCVA, final BCVA, donor-button cell count, and final cell count.
The average follow-up time for final BCVA and cell count was 11 months (range, 6 to 26 months; SD=6.62). Average endothelial cell loss between all eyes was 36.95% (range, 10.44% to 73.22%; SD=18.53) while the BCVA improved by an average of 3 lines (range, -1 to 8; SD=2.83). Three eyes had endothelial cell losses of more that 50% (range, 57.44% to 73.22%), but the BCVA improved in these eyes by an average of 4.67 lines (range, 3 to 8) from the pre-operative measure. Four eyes had cell losses less than 20% (range, 10.44% to 19.67%), but the average BCVA improvement was -0.25 lines (range, -1 to 0).
Endothelial cell count following DSEK did not directly correlate with final BCVA. Indeed, in the eyes reviewed above, those with more cell loss actually gained better BCVA than those eyes with fewer cell losses. While endothelial cell counts may be used to follow long-term graft viability, it cannot, by itself, be used to predict final BCVA. Longer term follow-up is needed to determine if the grafts with lower cell counts go on to fail with time. A prospective study is recommended to corroborate the data.
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