Abstract
Purpose :
Fuchs’ endothelial dystrophy (FED) is a degenerative condition of the corneal endothelium, leading to loss of corneal endothelial cells, potentially causing corneal haze and decreased vision. Various methods of corneal transplant may be performed to improve vision. Uveitis leads to anterior chamber pathology that may make surgeries, such as corneal transplants, more challenging and lead to worse outcomes or prognosis. We aimed to describe outcomes in patients with uveitis and FED after either Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping endothelial keratoplasty (DSEK), or penetrating keratoplasty (PK).
Methods :
This was a retrospective single-center study looking at uveitis patients who had keratoplasty from 2009 to 2022 at the Massachusetts Eye Research and Surgery Institution (MERSI), in Waltham, MA. All surgeries were performed by a single surgeon (S.A.). We defined success as stability or improvement in visual acuity after surgery without the need for regraft or other corneal transplantation for at least one year.
Results :
Ten eyes in 7 patients were included, with 18 procedures documented including 8 DSEK, 2 DMEK, and 8 PK. Of the 8 DSEK, there were 6 (75%) successes and 2 (25%) failures. Of the 2 DMEKs performed, one (50%) was a success and one (50%) was a failure. For the 8 PKs there were 7 (87.5%) successes and 1 (12.5%) failure.
Of the 8 DSEK, 5 (62.5%) were primary procedures and 3 (37.5%) were performed after either DMEK or PK. Of 5 primary DSEAK, 3 eventually required PK. Of 8 PKs, 2 were primary and 6 repeat procedures. One patient had repeat PK 3 times over 10 years, and then eventually DSEK. The remaining 3 cases of non-primary PK were performed after DSEK.
Conclusions :
In this study, PK was the most successful procedure, followed by DSEK and then DMEK. While successful, cases with uveitis and FED may be at an increased risk of repeat corneal transplantation.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.