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AAO report: DSEK and PK have similar risks, graft survival and visual acuity
Ophthalmology. 2009;116(9):1818-1830.
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Descemet's stripping endothelial keratoplasty was found to have surgical risks, complication rates and endothelial cell loss comparable to penetrating keratoplasty, a study showed.
The review of published peer-reviewed literature on DSEK was conducted by the American Academy of Ophthalmology.
"The most common complications of DSEK do not appear to be detrimental to the ultimate vision recovery in most cases," the study authors said. "Long-term endothelial cell survival and the risk of late endothelial rejection are beyond the scope of this assessment."
Investigators conducted literature searches in PubMed and the Cochrane Library, and selected 34 articles for review.
The most common complications of DSEK were posterior graft dislocation (mean 14%), endothelial graft rejection (mean 10%), primary graft failure (mean 5%) and iatrogenic glaucoma (mean 3%).
Average endothelial cell loss, based on specular microscopy, ranged from 25% to 54%. Average cell loss was 37% at 6 months and 42% at 12 months.
Average Snellen best corrected visual acuity at a mean 9 months ranged from 20/34 to 20/66. Induced hyperopia ranged from 0.7 D to 1.5 D. Induced astigmatism ranged from –0.4 D to 0.6 D. Mean refractive shift was 0.11 D. Graft survival at 1 year ranged from 55% to 100%, with a mean rate of 94%.
DSEK yielded better visual recovery, postoperative refraction and wound closure than PK, and it had lower rates of intraoperative and late suprachoroidal hemorrhage, the authors said.
Lee et al did a wonderful job of addressing the question: Is DSEK effective for treatment of corneal endothelial diseases? They are to be congratulated for reviewing 2,118 citations and 131 articles to arrive at the 34 articles used for the document’s information. As they note, endothelial keratoplasty (EK) was used for over 85% of the corneal transplants for endothelial dysfunction in 2007.
This document is very important as it places in perspective the advantages of EK compared to standard penetrating keratoplasty (PK). Documents such as this are essential for medicine, or ophthalmology, in dealing with insurance companies and other third party payers when trying to describe what a procedure is and why it is being used.
– Francis W. Price Jr., MD
OSN
Cornea/External Disease Board Member