Descemet-stripping automated endothelial keratoplasty: six-month results in a prospective study of 100 eyes

Abstract

Purpose: To report 6-month results in a large, prospective study of Descemet-stripping automated endothelial keratoplasty (DSAEK).

Methods: A 5-mm scleral-limbal tunnel approach was created for placement of an automated microkeratome-prepared 8.0-mm endothelial graft after DSAEK in 150 consecutive cases between September 2005 and October 2006. Six-month follow-up data were available on 100 eyes. Intraoperative peripheral scraping was performed to promote adherence of the donor. Preoperative and postoperative visual acuity with and without spectacle correction (BSCVA and UCVA), refractive astigmatism, average topographic keratometry, surface asymmetry index, surface regularity index, and pachymetry were measured prospectively.

Results: After DSAEK surgery, average BSCVA improved from 20/86 to 20/38, and average UCVA improved from 20/155 to 20/73, which were both statistically significant (P < 0.05). Excluding 26 eyes with known retinal pathology: 97% of the 74 eyes had a vision of 20/40 or better at 6 months and 14% obtained 20/20 or better. Refractive astigmatism changed an average 0.06 D, and average topographic keratometry changed an average -0.13 D, which were not statistically significant. Surface regularity index and surface asymmetry index improved to normal levels of 0.67 and 1.03, respectively (P < 0.001 and P = 0.002). Pachymetry decreased significantly from 0.70 to 0.66 mm (P = .001).

Conclusions: This large prospective study of DSAEK shows that this surgery provides a significant improvement in vision, corneal thickness, and surface regularity. It does not change refractive astigmatism or average topographic keratometry significantly. This newer technique of endothelial keratoplasty yields many of the benefits of its predecessors, deep lamellar endothelial keratoplasty and posterior lamellar keratoplasty, while improving the visual results.