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J. Baqai, R. Grostern, J. Rubenstein; Changing Indications for Penetrating Keratoplasty With the Introduction of Descemet's Stripping Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2010;51(13):744.
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Investigate the indications for penetrating keratoplasty prior to the introduction of Descemet’s stripping endothelial keratoplasty (DSEK) at our facility
256 pathology reports of corneal buttons were reviewed to investigate the indications for penetrating keratoplasty (PK) for the four years prior to the introduction of Descemet’s stripping endothelial keratoplasty (DSEK) at our facility. The data were then used to determine which cases might have qualified for Descemet’s stripping endothelial keratoplasty (DSEK) in place of PK.
313 pathologic diagnoses were made among the 256 patients over four years. 48 patients had two or more diagnoses. The most common diagnoses necessitating corneal transplants were endothelial decompensation (75 patients, 29.3%) and Fuchs’ dystrophy (50 patients, 19.5%). Fuchs’ dystrophy was identified by the presence of guttata while endothelial decompensation was recognized by diffuse loss of endothelial cells. Other diagnoses included keratoconus (38 patients, 14.8%), corneal graft failure (37 patients, 14.5%), corneal scarring (37 patients, 14.5%), keratitis (34 patients, 13.3%), corneal vascularization (14 patients, 5.5%), and corneal perforation (10 patients, 3.9%). 125 of 256 patients had diagnoses for which DSEK may have been appropriate. However, 26 of these 125 patients would not have been sufficiently cured by DSEK due to concurrent diagnoses with evidence of damage to other components of the cornea. This study shows that 99 of 256 patients, or 38.7%, had injury to the endothelium alone and would therefore have been potentially treated adequately by Descemet’s stripping endothelial keratoplasty.
This study shows that 99 of 256 patients, or 38.7%, had injury to the corneal endothelium alone and would therefore have been potentially treatable with Descemet’s stripping endothelial keratoplasty. It is our conclusion that Fuchs’ dystrophy and endothelial decompensation account for a substantial percentage of indications for penetrating keratoplasty in this study and that these conditions may be appropriately treated by DSEK instead of PK.
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