Study finds better visual recovery with DSAEK than PK, DLEK or DSEK

This prospective nonrandomized study compared outcomes of penetrating keratoplasty, deep lamellar endotheial keratoplasty (DLEK), Descemet's stripping endothelial keratoplasty (DSEK) and Descemet's stripping automated endothelial keratoplasty (DSAEK) performed by one surgeon. Subjects were 177 eyes (161 consecutive patients) with corneal edema due to Fuchs' endothelial dystrophy, pseudophakic bullous keratopathy, aphakic bullous keratopathy, failed graft or iridocorneal endothelial syndrome. One-year results indicated quicker and better UCVA and BCVA recovery and significantly lower astigmatism with DSAEK compared with the other procedures. Average endothelial cell loss was similar between the groups at 40.11 percent, but the dislocation rate was higher with DSAEK.

Forty-eight patients underwent PK, 68 DLEK, 16 DSEK and 45 DSAEK. Postoperative visual outcomes were included for DSAEK patients with at least six months of follow-up due to their stability of vision and refraction. The results indicated a trend of progressive improvement in visual outcomes from DLEK to DSEK to DSAEK and a significant improvement from DLEK to DSAEK. BSCVA was 20/44 after DSAEK, significantly better than 20/53 with PK and 20/80 with DLEK but statistically similar to DSEK (20/56). UCVA was 20/112 with PK, 20/96 with DLEK, 20/89 with DSEK and 20/71 with DSAEK.

Mean spherical equivalent was similar between the groups but tended toward hyperopia with DSAEK and DSEK. Average refractive astigmatism was 3.78 D following PK, significantly higher than 1.61, 1.86 and 1.36 after DLEK, DSEK and DSAEK. Early postoperative donor disc dislocations, the most common perioperative complication, occurred in six (8.8 percent) patients with DLEK, two (12.5 percent) with DSEK and seven (15.6 percent) with DSAEK. Primary graft failure occurred in one (2.1 percent) case with PK, two (2.9 percent) with DLEK and one (2.2 percent) with DSAEK.