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DSAEK yields better 5-year graft survival than PK in Asian eyes
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Descemet’s stripping automated endothelial keratoplasty resulted in better graft survival than PK in Asian patients with endothelial dystrophy, according to a study.
Data were culled from the Singapore Corneal Transplant Registry. The review included 828 consecutive patients who underwent DSAEK (423 eyes) or PK (405 eyes) for bullous keratopathy or Fuchs’ endothelial dystrophy at the Singapore National Eye Center.
Surgeries were performed using standardized techniques for both PK and DSAEK.
A large majority of patients were Chinese (76.6%) and more patients had bullous keratopathy than Fuchs’ endothelial dystrophy (68.1% and 31.9%, respectively; P < .001).
Of patients who underwent routine endothelial cell density (ECD) evaluation, ECD cell loss was found to be significantly greater in the PK group than in the DSAEK group. Furthermore, cumulative graft rejection was greater in the PK group than in the DSAEK group (14.1 vs. 5%; P < .001). Cumulative graft survival was significantly decreased in eyes with bullous keratopathy compared with eyes with Fuchs’ endothelial dystrophy (53.7 % vs. 81.9%; P < .001), and the greatest incidence of graft failure was caused by cytomegalovirus in PK eyes compared with DSAEK eyes. – by Kate Sherrer
Disclosure: Mehta and Tan have patents with Endoglide and receive royalties from Network Medical. All other authors report no relevant financial disclosures.
Perspective
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Amar Agarwal, MS, FRCS, FRCOphth
This is a very well conducted study that showcases 5-year graft survival comparing DSAEK with PK. In this study, patients with Fuchs’ endothelial dystrophy demonstrated better results as compared to bullous keratopathy and patients with DSAEK fared better than those who underwent PK. Eyes with bullous keratopathy are known to incite greater inflammatory response in eyes compared to Fuchs’ endothelial dystrophy. This could be a reason why eyes with Fuchs’ endothelial dystrophy tend to be better off than eyes with bullous keratopathy. The greatest advantage with the endothelial keratoplasty (EK) procedure is that there are no suture related complications or wound dehiscence.
The study authors also report less endothelial cell density loss in DSAEK than PK, bringing the topic of “proper handling of donor graft tissue” to the forefront.
Endothelial keratoplasty is the future of corneal surgery and the results of EK will eventually improve with further advancements in donor tissue handling and surgeon training.
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Ang M, et al. Ophthalmology. 2016;doi:10.1016/j.ophtha.2016.04.049.
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