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Marianne Price, Francis Price; Descemet stripping endothelial keratoplasty: 15-year outcomes. Invest. Ophthalmol. Vis. Sci. 2021;62(8):988.
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Endothelial keratoplasty has become the gold standard for treating corneal endothelial dysfunction, but little is known yet about the long-term outcomes. Therefore, this study was designed to evaluate 15-year outcomes of Descemet stripping endothelial keratoplasty (DSEK).
This retrospective, observational study assessed postoperative outcomes through 15 years in an initial consecutive series of 360 DSEK cases performed between December 2003 and December 2005 at a single center. The main outcomes were graft survival and immunologic rejection rates determined by Kaplan-Meier and proportional hazards analysis, central corneal thickness (CCT) measured with ultrasonic pachymetry, and best spectacle-corrected visual acuity (BSCVA) assessed with a Snellen chart.
The transplant indications were Fuchs dystrophy (n=301, 84%), bullous keratopathy (n=34, 9%), and previous keratoplasty failure (n=25, 7%), and the mean age at the time of DSEK was 69 ± 12 years. At 15 years, 50 grafts were replaced or failed (14%), 136 (38%) were in patients known to have died, and 55 of the remaining 174 grafts (32%) were examined. The 15-year graft failure/replacement rate was 22%, taking loss to follow up into consideration. Fifteen grafts were replaced within the first year because of early failure to clear (n=9) or unsatisfactory vision associated with excessive graft thickness or wrinkles (n=6), and 35 experienced late endothelial failure (11 after clinically evident immunologic rejection and 24 without evidence of rejection). Glaucoma filtration surgery (present in 34 eyes, 9%) was associated with a 4-fold increased risk of graft failure (p<0.0001). The median CCT remained stable at 650 to 660 microns from 6 months to 15 years. The median BCVA among all examined eyes was 20/40 from 3 to 12 months and 20/30 from 2 to 15 years.
DSEK provided superior long-term visual rehabilitation and had a 15-year survival rate comparable to that of the previous standard, penetrating keratoplasty, when performed for similar indications. The DSEK failures that occurred within the first year were mostly associated with the learning curve at a time when techniques and instrumentation were still being developed and refined.
This is a 2021 ARVO Annual Meeting abstract.
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