Donor and Recipient Characteristics in the DSAEK vs. PKP Study

Abstract

Purpose: : The purpose of this study is to compare Descemet stripping automated endothelial keratoplasty (DSAEK) to penetrating keratoplasty (PKP) as a surgical alternative to replace diseased corneal endothelium. There is limited data on the long-term performance of DSAEK vs. PKP and no objective studies regarding endothelial cell loss using specular endothelial images analyzed by the same reading center.

Methods: : Donor and recipient characteristics from 164 subjects undergoing DSAEK employing Cornea Donor Study (CDS) eligibility criteria were gathered prospectively from two clinical sites (FP and MG) and associated eye banks (Vision Share). Specular endothelial images of the donors along with images taken at 6 and 12 months postoperatively were analyzed by the Specular Microscopy Reading Center (CWRU). Data was compared to 377 CDS/PKP subjects who had 12 month endothelial images read by the same reading center.

Results: : Subject characteristics for the DSAEK and CDS/PKP cohorts were comparable. Mean recipient age was 72 years vs. 70 years and female gender was 61% vs. 60% in the DSAEK vs. CDS/PKP groups, respectively. Primary endothelial failure was the indication for keratoplasty in both groups with Fuchs’ dystrophy as the predominant cause (86% in DSAEK group and 66% in the CDS/PKP group). Mean age for donors in the DSAEK group was 54 years vs. 57 years in the CDS/PKP group. There was one primary donor failure in each group. There were 5 donor dislocations (3.4%) in the DSAEK group. 6-month results exhibited a wide variability of endothelial cell loss in both study groups.

Conclusions: : Donor and recipient characteristics in the DSAEK group were similar to the CDS/PKP group enabling a valid comparison of graft survival and cell loss for the two groups at one year. The rate of donor dislocation in our DSAEK study group was lower than in previous reports. Long term graft and endothelial cell survival at 1 year in our study group remains to be determined.

Keywords: cornea: clinical science • transplantation