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Repeat DSAEK yields similar endothelial cell loss, visual outcomes to primary procedure
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Repeat Descemet’s stripping automated endothelial keratoplasty produced endothelial cell loss rates and visual acuity results comparable to those of a primary procedure, according to one study.
The retrospective paired comparison included 51 eyes that underwent one or more DSAEK procedures following primary DSAEK between January 2005 and June 2015 at Villa Serena-Villa Igea Private Hospitals in Forli, Italy. Primary and secondary results of DSAEK surgeries were compared.
Primary DSAEK was performed for pseudophakic bullous keratopathy in 21 patients, Fuchs’ endothelial keratoplasty in 20 patients, failed PK in nine patients and trauma in one patient. Second procedures were performed in 35 patients for endothelial cell loss, in 15 patients for endothelial cell rejection and in one patient for host-graft interface.
Preoperative and postoperative best spectacle corrected visual acuity in both primary and subsequent DSAEK were not statistically significant, nor was postoperative spherical equivalent. However, there was a trend toward induced myopia after the subsequent DSAEK (P = .08).
Mean postoperative endothelial cell loss rates were similar in both groups, although rates were higher in the present study after repeat DSAEK than in previous studies reporting on primary DSAEK, the authors said.
“A possible reason for the accelerated cell loss could relate to a stronger immune response after the repeat graft. However, in our paired comparison (same patient, same eye), ECL rates did not differ between primary and repeat DSAEK. This is no surprise, as our study selected eyes that had, for whatever reason, unfavorable conditions for graft survival in their first DSAEK, which led to their failure,” the study authors wrote. – by Kate Sherrer
Disclosure: Busin reports he receives travel expenses and royalties from Moria (Antony, France). All other authors report no financial relationships.
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Nahum Y, et al. Cornea. 2016;doi:10.1097/ICO.0000000000000810.
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