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10 year graft survival and clinical outcomes of Descemet's stripping endothelial keratoplasty

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First Author: L.Fu UK

Co Author(s):    E. Hollick                    

Abstract Details

Purpose:

To evaluate the 10-year graft survival, endothelial cell loss (ECL) and clinical outcomes after Descemet's stripping endothelial keratoplasty (DSEK) including risk factors for graft failure.

Setting:

Department of Ophthalmology, King’s College Hospital NHS Foundation Trust, London, UK.

Methods:

356 eyes (263 patients) undergoing DSEK between January 2006 and January 2020 with at least 6 months postoperative follow-up from a prospectively maintained corneal graft database were reviewed. Kaplan-Meier analysis and Cox proportional hazards modelling were used to estimate cumulative graft survival and annual percentage ECL. Risk factors for graft failure, postoperative complications, and visual outcomes up to 10 years postoperatively are described.

Results:

Cumulative graft survival at 1, 3, 5, and 10 years were 98%, 93%, 91%, and 87%. Endothelial cell counts were measured in over 67% of patients at each follow-up. Percentage ECL of all grafts were 46.5 ± 17.47 at year 1, 54.9 ± 18.7 at year 3, 59.21 ± 16.58 at year 5 and 75.65 ± 8.53 at year 10. Cox proportional hazards regression identified preoperative glaucoma (HR 1.988, 95% CI, 1.051-3.762, P=0.035), including previous glaucoma surgery (HR 6.041, 95% CI, 2.151-16.964, P=0.001), and regrafts (HR 5.097, 95% CI, 2.177-11.931, P=0.001) as significant risk factors for graft failure.

Conclusions:

This is the longest follow-up reported after DSEK in the UK. We show excellent graft survival of 87% at 10 years and comparable ECL to the only other DSEK study in the literature with 10 years follow-up. DSEK remains a viable treatment option, especially in complex eyes with comorbidity.

Financial Disclosure: