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S. Martel, C. Shih, I. Udell; A Comparative Study of Descemet Stripping Automated Endothelial Keratoplasty versus Penetrating Keratoplasty in Fellow Eyes. Invest. Ophthalmol. Vis. Sci. 2010;51(13):745.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the quality of visual acuity achieved in patients who had Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in one eye and penetrating keratoplasty (PK) in the fellow eye.
This is a retrospective review of 12 patients who underwent DSAEK in 1 eye and PK in the fellow eye. Outcomes measured include: corneal curvature, spherical equivalent, best corrected visual acuity (BCVA), rates of rejection and primary graft failure, and subjective visual improvement in each eye.
12 patients (mean age, 76.9) who had Fuch’s endothelial dystrophy and/or pseudophakic bullous keratopathy underwent DSAEK in one eye and PK in their fellow eye. Mean follow-up time after most recent DSAEK was 26 months (range 4-43 months). In the PK group 41.6% had more than 1 PK, in the DSAEK group, all patients underwent primary transplantation. There were 5 graft failures in the PK group (1/5 was rejection). Of the DSAEK group, 1 eye (8.3%) underwent a graft rejection episode as compared to 1 (8.3%) of the PK group. The single DSAEK rejection was successfully reversed. The PK rejection resulted in graft failure.Of the 10 patients with good visual potential, the average best corrected visual acuity (BCVA) in the DSAEK group was 20/50 as compared to 20/60 in the PK group. The average spherical equivalent (SE) in the DSAEK group was +0.12±0.71D (average corneal astigmatism: 2.8±1.6D). In the PK group the average SE was -2.0±4.4D (average corneal astigmatism: 7±4.9D). Subjectively patients all preferred the vision in their DSAEK eye as compared to their PK eye even in if the Snellen acuity was not comparable.
DSAEK has many advantages over PK. Our results suggest decreased incidence of graft failure and rejection compared to PK. Subjectively, patients preferred the vision in their DSAEK eye as compared to their PK eye. In addition to this, DSAEK’s resulted in more neutral refractions as compared to PK’s.
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