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M. L. Salvetat, F. Miani, M. W. Zeppieri, L. Parisi, M. Felletti, P. Brusini; Functional and Morphological Results After Descemet Stripping and Automated Endothelial Keratoplasty: 2-Year Follow-Up. Invest. Ophthalmol. Vis. Sci. 2010;51(13):761.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate visual acuity (VA), refractive outcomes, postoperative complications and endothelial cell density (ECD) after Descemet stripping and automated endothelial keratoplasty (DSAEK).
This noncomparative surgical case series study included 22 eyes of 21 consecutive subjects (mean age of 73±9 years, range 54-89) undergoing DSAEK for Fuchs endothelial dystrophy (12 eyes), pseudophakic bullous keratopathy (7 eyes) or endothelial fealure after penetrating keratoplasty (3 eyes), with (8 eyes) or without (16 eyes) simultaneaous phacoemulsification and intraocular lens (IOL) implantation. Best spectacle-corrected VA (BSCVA), manifest refractive spherical-equivalent (MRSE), topographic astigmatism (TA), central corneal thickness (CCT) and ECD were assessed postoperatively at 6, 12 and 24 months and compared with preoperative parameters (ECD obtained from eye bank clinical chart) using the Student t-test. Multivariate analysis of variance was used to identify pre-intra- and post-operative factors associated with the postoperative donor ECD loss.
The minimum follow-up in all patients was 1 year; 12 eyes had a 2 year follow-up. The mean BSCVA significantly improved from 0.1±0.1 pre- to 0.5±0.2, 0.6±0.2 and 0.7±0.2 post-operatively at 6, 12 and 24 months respectively. A slight hyperopic shift of 0.75±1.5 D in MRSE (not statistically significant) was observed postoperatively in eyes not undergoing simultaneous phaco and IOL implantation. TA did not change significantly after surgery. The mean CCT significantly decreased from 813±181µm pre- to 616±95 1 year post-operatively. The mean ECD significantly decreased from 2727±102 cells/mm2 pre- to 1598±345, 1378±374 and 1303±391 post-operatively, at 6, 12 and 24 months respectively. Three eyes showed graft dislocation and required repositioning by air bubble injection; 4 eyes had secondary glaucoma. ECD loss was significantly related to the presence of secondary glaucoma (p=0.04) and repositioning of a dislocated graft (p=0.001).
BSCVA improved postoperatively in all eyes, showing a slight hyperopic shift without significant induced astigmatism. The donor ECD decrease was approximately 40% at 6 months, and 50% after 2 years. ECD loss was significantly greater in eyes showing post-operative secondary glaucoma or those requiring repositioning of the dislocated graft.
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