Endothelial keratoplasty: Indications and Outcomes

Abstract

Purpose: The authors present a study of the indications, visual outcomes and complications of 57 eyes of 51 patients submitted to Descemet Stripping Automated Endothelial Keratoplasty.
Introduction: The surgical treatment of endothelial disease is now mainly performed with Endotelial Keratoplasty. Fuchs endothelial dystrophy and pseudophakic bullous keratopathy are the two most common indications. The surgical procedure consists in stripping Descemet’s membrane and endothelium from the recipient and joining the donor tissue using an air bubble.
Methods: Observational study of 57 eyes of 51 patients submitted to DSAEK from 2011 to 2013 by the same surgical team. Indications, visual acuity progress and complications were analyzed. The outcome dissimilarity between the different indications was studied. A comparison between DSAEK and the combined procedure with phacoemulsification was also done.
Results: 63.2% were women. Patients had a mean age of 68±11.27 years. Pseudophakic bullous keratopathy was the indication in 47.4% of the cases, Fuchs endothelial dystrophy in 43.9%, bullous keratopathy after AC IOL implantation in 7.0% and after penetrating keratoplasty in 1.8%. A combined procedure with phacoemulsification and IOL implantation was performed 15.8% of the cases. There were no intraoperative complications. Preoperative average visual acuity was 0.22±0.15 and best postoperative average visual acuity was 0,60±0,23. The postoperative complication rate was 15.8% and included graft failures, dislocations and vitritis.
Conclusion: An ample average visual acuity increase was obtained, comparable to those described by other studies with a fast visual recovery associated with less postoperative inflammation. Postoperative complication rate was also within the expected results. In patients with endothelial dysfunction DSAEK is now a secure alternative to penetrating keratoplasty.