Korean J Ophthalmol.  2016 Dec;30(6):443-450. 10.3341/kjo.2016.30.6.443.

Comparison of Long-term Clinical Outcomes between Descemet's Stripping Automated Endothelial Keratoplasty and Penetrating Keratoplasty in Patients with Bullous Keratopathy

• Kim SE
• Lim SA
• Byun YS
• Joo CK

• KMID: 2374002
• DOI: http://doi.org/10.3341/kjo.2016.30.6.443

Abstract

PURPOSE
To compare 2-year clinical outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) in patients with bullous keratopathy.
METHODS
A retrospective chart review was performed to obtain 2 years of follow-up data of DSAEK or PK at a single center from March 2009 to September 2012. The study comprised 15 eyes of DSAEK and 11 eyes of PK. Outcome measures included best-corrected visual acuity (BCVA), spherical and keratometric changes, central corneal thickness, endothelial cell density, intraocular pressure, and postoperative complications. Graft survival rate was assessed by Kaplan-Meier survival analysis.
RESULTS
There were no differences in patient baseline characteristics between the two groups. At postoperative 2 years, better BCVA of 0.69 ± 0.51 logarithm of the minimum angle of resolution (logMAR) was found after DSAEK compared to 0.88 ± 0.48 logMAR after PK. Refractive cylinder in DSAEK and PK was −2.60 ± 1.53 and −6.00 ± 1.05 diopters (D), respectively, and keratometric cylinder was 3.27 ± 3.70 and 6.34 ± 3.51 D, respectively, at postoperative 2 years. The difference of mean spherical equivalents between postoperative 1 month and 2 years was 0.84 D after DSAEK and 2.05 D after PK. A hyperopic shift of 1.17 D was present after 2 years of DSAEK. The mean endothelial cell density at postoperative 2 years was 1,548 ± 456 cells/mm² for DSAEK and 1,052 ± 567 cells/mm² for PK, with a cell loss of 19.96% vs. 52.38%, respectively when compared to postoperative 1 month. No significant difference in central corneal thickness was found between DSAEK and PK (592 ± 75 vs. 563 ± 90 µm, respectively). Finally, the 2-year survival rate did not differ significantly between DSAEK and PK (93.3% vs. 81.8%, respectively, p = 0.344).
CONCLUSIONS
Compared to PK, DSAEK provided more stable refractive errors with better visual outcome, lower endothelial cell loss, and a lower rate of graft rejection at postoperative 2 years in patients with bullous keratopathy.

Keyword

Bullous keratopathy; Clinical outcomes; Descemet stripping endothelial keratoplasty; Penetrating keratoplasty

MeSH Terms

Cornea/diagnostic imaging/*surgery
Corneal Diseases/diagnosis/*surgery
Descemet Stripping Endothelial Keratoplasty/*methods
Female
Follow-Up Studies
Graft Survival
Humans
Keratoplasty, Penetrating/*methods
Male
Middle Aged
*Refraction, Ocular
Retrospective Studies
Time Factors
Treatment Outcome
Visual Acuity

Figure

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  Fig. 1 Comparison of best-corrected visual acuity (BCVA) between Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK).

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  Fig. 2 Comparison of mean spherical equivalent between Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK).

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  Fig. 3 Kaplan-Meier survival curves comparing Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK).

Reference

1. Koenig SB, Covert DJ, Dupps WJ Jr, Meisler DM. Visual acuity, refractive error, and endothelial cell density six months after Descemet stripping and automated endothelial keratoplasty (DSAEK). Cornea. 2007; 26:670–674.

2. Ratanasit A, Gorovoy MS. Long-term results of Descemet stripping automated endothelial keratoplasty. Cornea. 2011; 30:1414–1418.

3. Chen ES, Terry MA, Shamie N, et al. Descemet-stripping automated endothelial keratoplasty: six-month results in a prospective study of 100 eyes. Cornea. 2008; 27:514–520.

4. Terry MA, Shamie N, Chen ES, et al. Precut tissue for Descemet's stripping automated endothelial keratoplasty: vision, astigmatism, and endothelial survival. Ophthalmology. 2009; 116:248–256.

5. Anshu A, Price MO, Tan DT, Price FW Jr. Endothelial keratoplasty: a revolution in evolution. Surv Ophthalmol. 2012; 57:236–252.

6. Nanavaty MA, Wang X, Shortt AJ. Endothelial keratoplasty versus penetrating keratoplasty for Fuchs endothelial dystrophy. Cochrane Database Syst Rev. 2014; (2):CD008420.

7. Jun B, Kuo AN, Afshari NA, et al. Refractive change after Descemet stripping automated endothelial keratoplasty surgery and its correlation with graft thickness and diameter. Cornea. 2009; 28:19–23.

8. Wacker K, Baratz KH, Maguire LJ, et al. Descemet stripping endothelial keratoplasty for Fuchs' endothelial corneal dystrophy: five-year results of a prospective study. Ophthalmology. 2016; 123:154–160.

9. Price MO, Gorovoy M, Price FW Jr, et al. Descemet's stripping automated endothelial keratoplasty: three-year graft and endothelial cell survival compared with penetrating keratoplasty. Ophthalmology. 2013; 120:246–251.

10. Ang M, Mehta JS, Lim F, et al. Endothelial cell loss and graft survival after Descemet's stripping automated endothelial keratoplasty and penetrating keratoplasty. Ophthalmology. 2012; 119:2239–2244.

11. Terry MA, Chen ES, Shamie N, et al. Endothelial cell loss after Descemet's stripping endothelial keratoplasty in a large prospective series. Ophthalmology. 2008; 115:488–496.e3.

12. Price MO, Price FW Jr. Endothelial cell loss after Descemet stripping with endothelial keratoplasty influencing factors and 2-year trend. Ophthalmology. 2008; 115:857–865.

13. Busin M, Bhatt PR, Scorcia V. A modified technique for Descemet membrane stripping automated endothelial keratoplasty to minimize endothelial cell loss. Arch Ophthalmol. 2008; 126:1133–1137.

14. Price MO, Gorovoy M, Benetz BA, et al. Descemet's stripping automated endothelial keratoplasty outcomes compared with penetrating keratoplasty from the Cornea Donor Study. Ophthalmology. 2010; 117:438–444.