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DSAEK causes more immediate cell loss but less over time than penetrating keratoplasty

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SAN FRANCISCO — Endothelial cell loss may be more dramatic after Descemet's stripping automated endothelial keratoplasty compared with penetrating keratoplasty immediately after surgery, but long-term results favor the newer technique, a speaker said here.

Published studies to date comparing the two procedures have documented a better prognosis for patients undergoing DSAEK despite a greater proportion of patients receiving a transplant for Fuchs' Dystrophy, Jonathan H. Lass, MD, said during Refractive Subspecialty Day prior to the American Academy of Ophthalmology meeting.

These studies have noted a higher occurrence of perioperative trauma and a 15% higher repositioning rate with DSAEK compared with PK, Dr. Lass said. Published comparative studies have noted a two-times higher rate of endothelial cell loss in the first 6 months after DSAEK compared with PK (around 30% to 35%), but a stable rate thereafter to a maximum of 4 years in clinical follow-up data, Dr. Lass said.

By contrast, penetrating keratoplasty tends to have a much slower rate but more consistent rate of endothelial cell loss in the postoperative period, which eventually results in greater overall cell loss after about 3 years, Dr. Lass said.