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  • Graft survival remains high even 10 years after DSEK

    Cornea/External Disease

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    Review of: Long-term outcomes of Descemet stripping endothelial keratoplasty: Ten-year graft survival and endothelial cell loss

    Fu L, Hollick E. American Journal of Ophthalmology, February 2022

    Investigators conducted a retrospective review of long-term data (up to 10 years) to identify risk factors affecting graft survival in eyes undergoing Descemet stripping endothelial keratoplasty (DSEK) for several corneal conditions, as well as the significance of endothelial cell density.

    Study design

    The grafts reviewed were performed over a 15-year period at a single institution in the United Kingdom. Eyes were included if they had a follow-up of at least 6 months (356 eyes in 263 patients). The primary outcomes were cumulative graft survival and percentage of endothelial cell loss during the follow-up period (6 months to 10 years).

    Outcomes

    Overall graft survival rates were 97%, 90%, 85%, and 79% at 1, 3, 5, and 10 years, respectively. Preoperative glaucoma (hazard ratio [HR] 8.41), non–Fuchs endothelial dystrophy indication (HR 5.54), regrafts (HR 5.29), and prior glaucoma surgery (HR 3.63) were the risk factors that had the most significant association with graft failure. Importantly, the study found that though the DSEK grafts had a mean endothelial cell density of 692 cells/mm2 at the 10-year mark, they often stayed clear without significant clinical thickening; 91% of the eyes with 10 years of follow-up achieved a visual acuity of ≥0.3 logMAR.

    Limitations

    The primary limitation of this study was that not all patients who had DSEK grafts reached 10 years of follow-up. Additional limitations include surgeon learning curves and surgical technique.

    Clinical significance

    Given the excellent survival of grafts for up to 10 years, DSEK remains a promising treatment option in complex eyes with serious ocular comorbidities. However, endothelial cell density is not a perfect marker for graft health, as even low endothelial counts can be associated with clear and viable grafts.