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Long-term results assuage fears over endothelial cell loss in EK
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NAPLES, Italy — Outcomes of a large series of endothelial keratoplasty procedures, both Descemet's stripping with endothelial keratoplasty and Descemet's stripping automated endothelial keratoplasty, with a follow-up of more than 3 years, provide reassuring endothelial cell count data, rejection rate and, hopefully, long-term graft survival, according to a speaker here.
"Endothelial keratoplasty has been rapidly adopted," Francis W. Price Jr., MD, said at the joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology. "However, concerns have been raised by the somewhat higher rate of endothelial cell loss compared to that reported in recent penetrating keratoplasty series."
EK requires more donor tissue manipulation than PK, both in the stage of preparation and graft insertion, and this inevitably has an impact on early cell loss.
"We have now performed over 1,000 EK procedures and have experienced different and increasingly better techniques. Our outcomes show that the type and width of incision and the devices used for insertion have a significant influence on early endothelial cell loss," Dr. Price said.
Several of the newer forceps designs can help reduce tissue damage when the donor button is folded for insertion. Newer techniques, such as Busin's insertion through a funnel glide, are also less traumatic and allow for a gentler placement of the graft into the recipient eye through a smaller incision.
"Although the mean 6-month cell loss in our DSEK series was higher than in our own and other recent PK series, subsequent cell loss at 1, 2 and 3 years has been minimal, and the mean cell loss at 3 years is well within the range seen after PK," Dr. Price said. These findings, he noted, may help alleviate concerns about long-term EK graft survival.
"Of course, graft rejection is a concern after EK, just as it is after standard PK. However, since wound healing is not a significant concern after EK, many surgeons leave EK patients on low-dose topical steroids indefinitely, and this may help reduce the risk of graft rejection," he said.