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Comparative Study
. 2018 Oct 5;13(10):e0203993.
doi: 10.1371/journal.pone.0203993. eCollection 2018.

Corneal transplantation for Fuchs´ endothelial dystrophy: A comparison of three surgical techniques concerning 10 year graft survival and visual function

Jeroen van Rooij  1 , Elsina H Lucas  1 , Annette J Geerards  1 , Lies Remeijer  1 , Rene Wubbels  1
Affiliations
Comparative Study

Corneal transplantation for Fuchs´ endothelial dystrophy: A comparison of three surgical techniques concerning 10 year graft survival and visual function

Jeroen van Rooij et al. PLoS One. .

Abstract

Objective: Comparison of conventional Penetrating Keratoplasty (PKP), posterior mushroom PKP and Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) regarding overall graft survival of primary corneal transplants for Fuchs´ endothelial dystrophy (FED), best spectacle-corrected visual acuity (BSCVA) and astigmatism.

Methods: Single centre study using prospectively collected data from the national database for follow-up of corneal transplants. Main outcome parameters: 10 years graft survival, astigmatism at 24 months, pre- and post-operative BSCVA.

Results: In total, 721 cases were included: PKP, n = 171; posterior mushroom PKP, n = 91; and DSAEK, n = 459. There was no significant difference in graft survival between PKP, posterior mushroom PKP and the DSAEK technique (log-rank test, P = 0.12). The overall post-operative BSCVA improvement in all treatment groups was significant (paired t-test, P<0.001). Pre-operative BSCVA was better for the DSAEK group (0.68 ± 0.41 logMAR) as compared to the PKP (0.89 ± 0.53) and posterior mushroom PKP group (0.90 ± 0.58); ANOVA, P<0.001. After 24 months, BSCVA was significantly better for the DSAEK group (0.25 ± 0.26 logMAR) compared to the PKP (0.35 ± 0.29) and posterior mushroom PKP group (0.41 ± 0.42); ANOVA, P<0.001. A significant difference in astigmatism was found (median test, P<0.001) between the DSAEK (1.7 ± 1.1 D), PKP (4.6 ± 2.7 D) and posterior mushroom PKP group (4.5 ± 3.3 D). The significantly lower DSAEK-induced astigmatism was confirmed by vector analysis.

Conclusion: There was no difference in graft survival and BSCVA improvement between conventional PKP, inverted mushroom PKP and DSAEK in this study. The significantly lower changes in astigmatism, wound stability and faster visual rehabilitation with DSAEK surgery are favourable aspects of this technique. The benefits of posterior lamellar keratoplasty warrant earlier intervention, which may contribute to preserve better vision for a prolonged period of remaining lifetime.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The annual number of cornea transplantations for Fuchs' endothelial dystrophy (N) in the Rotterdam Eye Hospital between 2002 and 2012.
Penetrating Keratoplasty (PKP), posterior mushroom PKP, Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK).
Fig 2
Fig 2. Graft survival for Penetrating Keratoplasty (PKP), posterior mushroom PKP (Mushroom) and Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).
Log-rank test: p = 0.12.
Fig 3
Fig 3. Average preoperative- and postoperative BSCVA after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK; upper curve) and after pentrating keratoplasty (PKP & mushroom PKP; lower curve).
Error bars represent 95% confidence intervals. As the BSCVA of PKP and posterior mushroom PKP were similar, both preoperatively and during the entire follow- up period, data of patients that underwent penetrating keratoplasty were combined.
Fig 4
Fig 4. Double angle plot of surgically induced astigmatism showing the change of astigmatism at 2 years relative to baseline differentiated by the technique that was used: Penetrating Keratoplasty (PKP), posterior mushroom PKP, Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).
Rings at 5, 10 and 15 Diopters.
See this image and copyright information in PMC

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