DSEK graft survival rate high at 10 years
Outcomes from 10 years of follow-up show that Descemet’s stripping endothelial keratoplasty is a viable treatment option, with a high rate of graft survival over the long term, according to one speaker.
“We showed excellent graft survival of 87% at 10 years and comparable [endothelial cell loss] to the only other DSEK study with an equally long follow-up in the literature,” Lana Fu, MD, said at the virtual European Society of Cataract and Refractive Surgeons winter meeting.
This was, she said, the longest follow-up series for DSEK in the U.K., including 356 eyes of 263 patients who underwent DSEK in a single center between January 2006 and January 2020. Of these, 50% had Fuchs’ endothelial dystrophy (FED), 25% had pseudophakic bullous keratopathy (PBK), and 5% had previous graft failure. Ten surgeons performed the DSEK surgery using a standardized technique. The donor grafts were manually dissected, and insertion was done with forceps initially, with the Busin glide from 2007 and with the Tan EndoGlide from 2010.
Fu reported that 15% of eyes had interface fluid, and rebubbling was performed in 8% of eyes when the area of interface fluid exceeded one-third of the total graft. A rejection episode occurred in 20% of eyes, of which half had preoperative glaucoma. Fourteen percent of eyes developed graft failure, of which half underwent re-transplantation.
“Cumulative graft survival was 91% at 5 years and 87% at 10 years. [Endothelial cell loss] was 60% at 5 years and 76% at 10 years,” Fu said. “At 10 years, 95% of eyes had 0.3 logMAR vision or better, which corresponds to the threshold requirement for driving in the U.K.”
Significant risk factors for graft failure were preoperative glaucoma, re-graft and non-FED indications.
“Subgroup analysis found lower cumulative graft survival in glaucomatous eyes of 52% at 5 years and 35% at 10 years. Survival for the PBK eyes was 89% at 5 years and 62% at 10, as compared with 97% and 92% in eyes with FED,” Fu said.
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Fu K, et al. 10 year graft survival and clinical outcomes of Descemet’s stripping endothelial keratoplasty. Presented at: European Society of Cataract and Refractive Surgeons winter meeting; Feb. 19-21, 2021 (virtual meeting).
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