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  • Endothelial vs. Penetrating Keratoplasty: Practice Patterns and Long-Term Outcomes

    By Lynda Seminara and edited by Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, October 2016

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    Although endothelial keratoplasty (EK) has largely replaced penetrating kerato­plasty (PK) as the treatment of choice for Fuchs’ endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK), the superiority of EK for these indications was questioned in 2 recent registry studies. Thus, Dickman et al. compared long-term graft survival, best-corrected visual acuity (BCVA), endothelial cell density (ECD), and astigmatism after PK versus EK for FED and PBK. They found that, at 5 years postoperatively, graft survival and ECD were comparable for PK and EK, and BCVA and astigmatism were better with EK.

    The researchers analyzed data from the Netherlands Organ Transplant Registry of all patients with FED or PBK who underwent keratoplasty in the Netherlands between 1998 and 2014 (2,725 EK and 2,390 PK). They found that during the first 2 years, graft survival was significantly lower for EK than PK in patients with FED (95.2% vs. 97.4%) or PBK (88.7% vs. 94.5%). However, between 2 and 5 years, it was significantly better for EK than PK in patients with FED (98.2% vs. 95.2%) or PBK (97.2% vs. 85.9%). By year 5, graft survival had improved significantly in patients who under­went EK and had remained stable in those treated by PK.

    They also found that BCVA was significantly better following EK in patients with FED until 36 months postoperatively; the difference was not significant after that time. Among patients with PBK, EK resulted in significantly better BCVA through­out the study. Refractive astigmatism was substantially higher for PK for both conditions throughout the study period. At 1 year, ECD was significant­ly lower for EK for both conditions; at 3 years, there was no statistical difference between PK and EK in this outcome.

    The authors concluded that long-term graft survival is better after EK, whereas short-term survival is better after PK. Moreover, EK graft surviv­al increased over the course of the study, suggesting a learning curve and improved technique. Visual recovery is faster after EK compared with PK and is associated with minimal postopera­tive astigmatism and a mild hyperopic shift.

    The original article can be found here.