Corneal Endothelial Cell Loss and Graft Thickness Following Descemet-Stripping Automated Endothelial Keratoplasty

Abstract

Purpose: : To report the clinical outcomes of Descemet-Stripping Automated Endothelial Keratoplasty (DSAEK) focusing on the alteration of corneal endothelial cell density (ECD) and graft thickness.

Methods: : Clinical outcomes of DSAEK were evaluated retrospectively. Subjects involved 58 eyes in 56 cases including 11 eyes with pseudophakic bullous keratopathy (PBK), 18 eyes with laser iridotomy-induced bullous keratopathy, 11 eyes with Fuchs corneal dystrophy, 9 eyes with glaucoma-related disorders, and 9 other eyes. The minimum follow-up period in all cases was over 3 months. For the DSAEK, pre-cut donor corneas were inserted using a Busin glide. Specular microscopy was performed to monitor the ECD. Visante^TM OCT (Carl Zeiss) was used for corneal thickness measurement.

Results: : The average ECD of the donor corneas prior to pre-cut and post pre-cut was 2909±322 cells/mm² and 2692±344 cells/mm², respectively (Eye Bank records). The loss of ECD following the pre-cut procedure and the surgical DSAEK procedure was 7.5% and 20.4%, respectively. ECD gradually decreased to 2143±424 cells/mm², 1928±525 cells/mm², 1776±591 cells/mm², and 1644±599 cells/mm², at 1-, 6-, 12-, and 18 months post surgery, respectively. The loss of CED following the pre-cut procedure and the surgical DSAEK procedure was 9.1% and 20.6%, respectively. Postoperative follow-up showed that in 36 cases at more than 6 months after DSAEK, 19 cases showed reduction rates of CED between 1 month and the latest follow-up to be less than 10%, yet 17 cases showed a reduction rate of over 10% (average: 35.5%). The average of host corneal thickness altered from 767µm to 483µm at 1 month after the DSAEK procedure. The whole thickness of the central cornea after 12 months was 666µm, with no significant difference to that of at 1 month. However, the average of peripheral corneal thickness gradually reduced from 887µm (at 1 month) to 786µm (at 12 months).

Conclusions: : The results of this study show that DSAEK is an effective procedure for the recovery of corneal endothelial function and visual function. Graft wound-healing and corneal endothelial remodeling was shown to be influenced by multiple factors and continued for over 6 months after surgery.

Keywords: cornea: clinical science • cornea: endothelium • clinical (human) or epidemiologic studies: outcomes/complications