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At 3 years, visual acuity continues to improve after DSAEK
Late visual gains may result from tissue remodeling at the interface between the donor button and host stroma and within host subepithelial, stromal tissues.
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Descemet’s stripping automated endothelial keratoplasty gradually improved visual acuity in eyes with Fuchs’ endothelial dystrophy or pseudophakic bullous keratopathy and no ocular comorbidities, a study found.
Visual acuity improved steadily for up to 3 years postoperatively, the study authors said.
“The primary finding of the study is the trend towards continued improvement long-term after DSAEK surgery,” Jennifer Y. Li, MD, the corresponding study author, said in an email interview. “There was an increasing proportion of eyes reaching 20/20, 20/25 and 20/30 at every follow-up time point: 6 months, 12 months, 2 years, 3 years.”
The study was published in Ophthalmology.
Patients and technique
Li and colleagues retrospectively analyzed 365 eyes that underwent DSAEK for Fuchs’ endothelial dystrophy and pseudophakic bullous keratopathy. Ninety-five eyes were excluded because of ocular comorbidities such as age-related macular degeneration, cystoid macular edema, advanced glaucoma or significant anterior corneal scarring.
The final study group included 108 eyes that underwent evaluation of Snellen best corrected visual acuity preoperatively and at 6, 12, 24 and 36 months postoperatively. Mean patient age at the time of surgery was 67.1 years.
Eye bank and surgeon-prepared donor grafts were inserted through a 5-mm scleral incision 0.5 mm posterior to the temporal limbus. Insertion forceps were used to insert grafts in a 60:40 taco configuration.
Balanced salt solution was used to deepen the anterior chamber and make room for the donor tissue to unfold; air was injected to unfold the tissue.
Postoperative treatment included tapered topical prednisolone acetate 1% and topical antibiotics.
“The surgical technique as outlined in the paper is the standard technique for DSAEK surgery at the Devers Eye Institute,” Li said. “We find that it provides consistent, reliable results even in the most complex eyes. By minimizing trauma to the donor corneal tissue either intraoperatively or postoperatively from donor tissue dislocation, we believe that long-term outcomes can be optimized.”
Jennifer Y. Li
Results and conclusions
Study results showed statistically significant improvements in average BCVA at 6 months, 2 years and 3 years.
Preoperatively, BCVA was 20/40 in 49.1% of eyes, 20/30 in 21.3%, 20/25 in 6.5% and 20/20 in 0.9%.
At 6 months, BCVA was 20/40 in 94.4% of eyes, 20/30 in 67.6%, 20/25 in 36.1% and 20/20 in 11.1%.
At 12 months, BCVA was 20/40 in 93.5% of eyes, 20/30 in 75%, 20/25 in 39.8% and 20/20 in 13.9%.
At 24 months, BCVA was 20/40 in 98.1% of eyes, 20/30 in 84.3%, 20/25 in 59.3% and 20/20 in 34.3%.
At 36 months, BCVA was 20/40 in 98.1% of eyes, 20/30 in 90.7%, 20/25 in 70.4% and 20/20 in 47.2%.
The greatest improvement in vision was seen during the first 6 months postoperatively with the removal of corneal guttae and decreasing corneal edema, Li said.
“After this early postoperative period, reasons for improvement in vision are less obvious but may relate to corneal tissue remodeling at the interface between the donor button and the host stromal tissue and within the subepithelial and stromal layers of the host cornea,” she said.
Study results showed low rates of intraoperative and postoperative complications.
“With DSAEK surgery, one of the most common complications is donor tissue dislocation postoperatively,” Li said. “The overall rate of graft dislocation at our institution is just under 2%, with the rate of iatrogenic primary graft failure of less than 0.5%.” – by Matt Hasson