Failure rate after DSAEK linked to graft size, endothelial cell density

A bigger graft and a higher endothelial cell density were associated with a lower rate of graft failure after Descemet’s stripping automated endothelial keratoplasty, according to a study.

The prospective study included 131 patients who underwent DSAEK; 84 had Fuchs’ endothelial dystrophy, and 47 had pseudophakic bullous keratopathy.

Mean donor age was 69.4 years (range: 32 years to 96 years). Mean donor endothelial cell density was 2,775.6 cells/mm².

Patients were assigned to groups based on the size of the donor trephine: less than 9 mm (28 patients), 9 mm (52 patients) and 9.5 mm (51 patients).

Primary outcome measures were postoperative best corrected visual acuity and graft failure. Patients were followed for at least 1 year.

Mean logMAR BCVA improved from 1 preoperatively to 0.2 postoperatively; 80.5% of patients attained BCVA of 20/40 or better.

There were statistically significant associations between postoperative BCVA and endothelial cell density (P = .005), pseudophakic bullous keratopathy or Fuchs’ endothelial dystrophy (P = .004), risk factors (P = .007) and comorbidity (P = .016).

Endothelial graft failure occurred in 11 patients (8.4%); 17.86% occurred in the less than 9-mm group, 7.69% in the 9-mm group and 3.84% in the 9.5-mm group.

There were statistically significant associations between graft failure and endothelial cell density (P = .039) and graft trephine size (P = .04). – by Matt Hasson

Disclosure: The authors report no relevant financial disclosures.

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Source:

Romano V, et al. Br J Ophthalmol. 2015;doi:10.1136/bjophthalmol-2014-305648.