Descemet's Stripping Preferred in Corneal Transplant Keratoplasty

A new study suggests that the potential long-term benefits of Descemet's stripping automated endothelial keratoplasty (DSAEK) may outweigh the initial cell loss.

Researchers at Case Western Reserve University School of Medicine (Case Western; Cleveland, OH, USA) conducted a study to compare the outcomes of DSAEK in 173 subjects with a moderate risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema),with those of 410 subjects who underwent penetrating keratoplasty (PKP) and who had clear grafts with at least one postoperative specular image within a 15-month follow-up period. The main outcome measures were endothelial cell density (ECD) and graft survival at one year. ECD was determined from baseline donor, 6-month, and 12-month postoperative central endothelial images.

The results showed that although the DSAEK recipient group criteria were similar to the PKP group, Fuchs' dystrophy was more prevalent in the DSAEK group and pseudophakic corneal edema was less prevalent. The researchers found that the results indicate cell loss in DSAEK patients plateau more quickly than in those who undergo PKP, and theorize that this is due to greater surgical manipulation of the donated graft itself. The researchers also found that preoperative diagnosis affected endothelial cell loss over time; in the PKP group, the subjects with pseudophakic/aphakic corneal edema experienced significantly higher 12-month cell loss than the subjects with Fuchs' dystrophy, whereas in the DSAEK group, the 12-month cell loss was comparable for the two diagnoses. The study was published in the March 2010 issue of Ophthalmology.

"There is no question of the immediate benefits of DSAEK,” said senior author Professor Jonathan Lass, M.D., chair of the department of ophthalmology and visual sciences at Case Western. "These benefits include greater eye integrity due to a smaller wound; quicker recovery with less visual distortion; and decreased severity in postoperative surface problems, such as dry eye. The fact that the transplants are less susceptible to trauma is promising for this growing procedure.”

DSEAK and PKP are alternative methods of corneal transplant surgery for diseases affecting the back cell layer of the cornea, the endothelium, when the cornea swells due to Fuchs' dystrophy or pseudophakic/aphakic corneal edema, conditions affecting the function of the corneal endothelium. Both the operation and recovery time associated with DSAEK are shorter, since the 360-degree PKP wound is larger, weaker, and more prone to rupture.

Related Links:
Case Western Reserve University School of Medicine