Long-Term Results of Descemet's Stripping Automated Endothelial Keratoplasty in Korea

Jun Sung Lee; Yeoung Geol Park; Kyung Chul Yoon

doi:10.3341/jkos.2010.51.11.1431

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Lee, Park, and Yoon: Long-Term Results of Descemet's Stripping Automated Endothelial Keratoplasty in Korea

Original Article

J Korean Ophthalmol Soc 2010;51(11):1431-1437.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.11.1431

Long-Term Results of Descemet's Stripping Automated Endothelial Keratoplasty in Korea

Jun Sung Lee, MD, Yeoung Geol Park, MD, Kyung Chul Yoon, MD

Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea

Address reprint requests to Kyung Chul Yoon, MD Department of Ophthalmology, Chonnam National University Hospital #8 Hak-dong, Dong-gu, Gwang-ju 501-757, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: kcyoon@chonnam.ac.kr

Received 10 March 2010 Accepted 18 August 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the long-term results of Descemet's stripping automated endothelial keratoplasty in Korea (DSAEK).

Methods

Seven patients with bullous keratopathy who underwent DSAEK and who were followed-up for more than 18 months were reviewed retrospectively. Best corrected visual acuity, refraction, corneal thickness, and endothelial cell count were examined before and after surgery.

Results

The mean follow-up period was 19.9 ± 2.9 months (18 to 24 months), and the mean age was 61.42 ± 10.13 years (46 to 76 years). Six patients (85.7%) showed successful results after surgery. Best corrected visual acuity (logMAR) was significantly improved from 1.62 (median) to 1.15 (median) (p = 0.027) at one month after surgery and was maintained until the final follow-up period. There were no statistical differences in spherical ametropia or astigmatism before or 18 months after the operation. Graft failure was observed in one case, in which penetrating keratoplasty was performed 12 months after DSAEK.

Conclusions

Long term results of DSAEK showed fast visual recovery, low ametropia and astigmatism. DSAEK may be a good option for the surgical management of corneal endothelial disease.

Keywords: DSAEK, Graft failure, Refractive change

References

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Figure 1.

Boxplot showing changes of best corrected visual acuity in the patients who underwent Descemet's stripping automated endothelial keratoplasty (^* Wilcoxon signed rank test, p<0.05 between preoperative and postoperative results).

Figure 2.

Graphs showing changes in mean best corrected visual acuity over time in the patients who underwent penetrating keratoplasty (^* Paired t-test, p<0.05 between pre-operative and postoperative results).

Figure 3.

(A) Preoperative slit lamp photograph showing edema and diffuse haziness in the cornea. (B) At 18 months after Descemet's stripping automated endothelial keratoplasty, the corneal graft remains clear. (C) Pentacam demonstrates interface smoothness and regular thickness of the cornea. (D) Specular microscope reveals viable endothelial cells.

Table 1.

Demographics of patients who underwent Descemet's stripping automated endothelial keratoplasty

Case	Age (yrs)	Sex	Preoperative diagnosis	Preoperative CCT^* (μ m)	Preoperative BCVA^† (logMAR)	Endothelial cell count (cells/mm²)	Combined procedure
1	46	M^‡	Bullous keratopathy	924	1.4	Error	
2	55	M	Bullous keratopathy	1,014	1.4	Error	
3	56	M	Bullous keratopathy, aphakia	941	1.4	371	Scleral fixation of IOL^Π
4	61	M	Bullous keratopathy, aphakia	749	2.3	Error	Scleral fixation of IOL
5	70	F^§	Bullous keratopathy, cataract	723	1.7	Error	Phaco^# with IOL implantation
6	76	M	Bullous keratopathy, pseudophakia	1,006	1.7	281	
7	66	M	Bullous keratopathy, pseudophakia	864	1.7	498	

^* CCT = central corneal thickness

^† BCVA = best corrected visual acuity

^‡ M = male

^§ F = female

^Π IOL = intraocular lens

^# Phaco = phacoemulsification.

Table 2.

Refractive ametropia, astigmatism, central corneal thickness, and endothelial cell density before and after Descemet's stripping automated endothelial keratoplasty

	Before operation median (range)	Postoperative 12 months median (range)	Postoperative 18 months median (range)
Sphere (D)	−0.13 (1.5∼2.75)	+0.5 (0.25∼0.75)	+0.75 (0.25∼1.25)
Cylinder (D)	0.0 (2.5∼1.5)	+1.25 (−1.25∼2.0)	+0.75 (1.25∼2.0)
Spherical equivalent (D)	−0.5 (1.5∼3.5)	+1.0 (0.0∼1.5)	+1.0 (0.25∼2.25)
Central corneal thickness (μ m)	932.5 (723∼1014)	601^* (600∼716)	651^* (611∼701)
Endothelial cell density (cells/mm²)	Not applicable	1359 (1258∼1587)	1125 (998∼1262)

^* Statistically significant difference (Wilcoxon signed rank test, p < 0.05) between preoperative and postoperative results.

Table 3.

Overall visual and surgical results at 18 months and at last follow-up after Descemet's stripping automated endothelial keratoplasty

Case	Age (yrs)	Sex	Follow-up duration (mon)	Postoperative BCVA^* (logMAR) at 18 mon after DSAEK^#	Postoperative BCVA^* (logMAR) at last follow-up	Postoperative CCT^† (μ m) at 18 mon after DSAEK	Endothelial cell count (cells/mm²) at 18 mon after DSAEK	Complication and management
1	46	M^‡	18	0.7	0.7	611	1,154	
2	55	M	18	0.7	0.7	646	1,262	
3	56	M	24	0.9	0.8	628	998	Graft detachment → Air injection
4	61	M	24	1.1	0.9	700	1,256	
5	70	F^§	18					Graft failure → PKP^Π
6	76	M	18	0.4	0.4	698	1,096	
7	66	M	20	0.7	0.7	656	1,011	

^* BCVA = best corrected visual acuity

^† CCT = central corneal thickness

^‡ M = male

^§ F = female

^Π PKP = penetrating keratoplasty

^# DSAEK = Descemet's stripping automated endothelial keratoplasty.

Table 4.

Refractive ametropia, astigmatism, central corneal thickness, and endothelial cell density after Descemet's stripping automated endothelial keratoplasty and penetrating keratoplasty

	Postoperative 12 mon		Postoperative 18 mon
	DSAEK^*	PKP^†	DSAEK	PKP
	median (range)	mean ± SD	median (range)	mean ± SD^‡
Sphere (D)	+0.5 (0.25∼0.75)	−3.78 ± 1.64	+0.75 (0.25∼1.25)	−3.98 ± 1.86
Cylinder (D)	+1.25 (−1.25∼2.0)	−4.26 ± 2.33	+0.75 (−1.25∼2.0)	−4.52 ± 1.82
Central corneal thickness (μ m)	601 (600∼716)	598.33 ± 46.81	651 (611∼701)	609.18 ± 27.86
Endothelial cell density (cells/mm²)	1,359 (1258∼1587)	1,386.28 ± 192.92	1,125 (998∼1262)	1,298.00 ± 251.76

^* DSAEK = Descemet-stripping automated endothelial keratoplasty

^† PKP = penetrating keratoplasty

^‡ SD=Standard deviation.

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