DSAEK offers better visual outcomes than other keratoplasty techniques, study says

Patients can achieve faster and better recovery of uncorrected and best corrected visual acuity with less postoperative astigmatism after Descemet's stripping automated endothelial keratoplasty than after surgery using other keratoplasty techniques, a study found. However, graft dislocation rates may be higher after DSAEK.

Irit Bahar, MD, and colleagues evaluated visual outcomes, as well as intraoperative and postoperative complications, after using one of four surgical techniques to perform keratoplasty on 177 eyes of 161 patients with corneal edema in a prospective, comparative, randomized study. Specifically, 48 eyes received penetrating keratoplasty, 68 eyes received deep lamellar endothelial keratoplasty (DLEK), 16 eyes received Descemet's stripping endothelial keratoplasty (DSEK) and 45 eyes received DSAEK.

Follow-up averaged 13.6 months for the entire cohort.

At 12 months postop, BCVA averaged 20/53 in the PK group, 20/80 in the DLEK group, 20/56 in the DSEK group and 20/44 in the DSAEK group, the authors noted.

"The mean spherical equivalent was similar between groups, but tended toward hyperopia in the DSEK and DSAEK groups," they said.

Refractive astigmatism averaged 3.78 D in the PK group, 1.61 D in the DLEK group, 1.86 D in the DSEK group and 1.36 D in the DSAEK group (P < .0001).

Donor disc dislocations occurred during the early postoperative period among six patients (8.8%) in the DLEK group, two patients (12.5%) in the DSEK group and seven patients (15.6%) in the DSAEK group (P = .0004).

The investigators reported primary graft failures in one patient (2.1%) in the PK group, two patients (2.9%) in the DLEK group and one patient (2.2%) in the DSAEK group.

All detached grafts were successfully reattached.

At 1 year postop, cell loss was similar in the four surgical groups, averaging 40.11%, according to the study, published in the September issue of Ophthalmology.