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  • DSEK, PK cell densities comparable 10 years postoperatively


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    A 10-year retrospective study found comparable endothelial cell density (ECD) loss with Descemet stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty (PK).

    Study design

    Investigators included a total of 752 eyes from 590 patients undergoing DSEK surgery. The indications for surgery included Fuchs’ endothelial corneal dystrophy (FECD), pseudophakic or aphakic corneal edema (PACE), and other forms of endothelial dysfunction. PK data for patients with the same indications were obtained from the Cornea Donor Study.

    Outcomes

    Overall, the 10-year median cumulative cell loss in surviving grafts was 71% among DSEK recipients, comparable to PK at 76%. The authors assumed there would be less cell loss in DSEK based on 5-year data, but over the next 5 years, cell loss continued to increase in DSEK patients in a linear fashion. In contrast, PK eyes had a sharper decline in ECD in the first 5 years after surgery, which slowed significantly in the subsequent 5 years and stabilizing at the 10-year mark.

    Patients with PACE and prior glaucoma surgery had a faster decline in ECD in the first few years after DSEK surgery compared with other recipients. Older donor ages were also associated with slightly lower ECDs.

    Clinical significance

    Clinically, one of the most important findings from this study was the very weak correlation between 10-year DSEK ECD and baseline donor ECD. Donor ECD is not the most important factor in long-term ECD survival. Corneal surgeons need not be overly stringent in their donor ECD requirements for DSEK tissue.

    However, the positive correlation between 10-year and 6-month ECD highlights the importance of minimizing damage to the donor endothelium perioperatively to ensure the best long-term endothelial cell survival.