Long-term results of Descemet stripping automated endothelial keratoplasty.

PURPOSE: To report the long-term outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: A retrospective case series was conducted on 51 patients who underwent DSAEK 5 years ago. DSAEK was performed for Fuchs corneal dystrophy, pseudophakic or aphakic bullous keratopathy, or failed penetrating keratoplasty (PKP). Best spectacle-corrected visual acuity (BSCVA), endothelial cell counts (ECC), and current graft status were ascertained for the eyes included in the study. Episodes of rejection and need for repeat transplantation were also analyzed. RESULTS: Forty-seven of 51 eyes had clear grafts at the most recent postoperative visit. There were 4 graft failures treated with repeat DSAEK, and regrafts are also clear to date. One eye had an episode of rejection that was successfully treated with topical steroids. CONCLUSIONS: Long-term results of DSAEK were excellent. Grafts were clear despite lower than normal endothelial cell counts. To our knowledge, this is the longest running study of DSAEK outcomes to date.

Laser-assisted in situ keratomileusis or photorefractive keratectomy after descemet stripping automated endothelial keratoplasty.

PURPOSE: To report the outcomes of laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) after Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: A retrospective case series was conducted on 5 postoperative unilateral DSAEK cases that underwent LASIK or PRK. DSAEK was performed for Fuchs corneal dystrophy and pseudophakic bullous keratopathy. Postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and current graft status were ascertained for the 5 eyes included in the study. RESULTS: All eyes had clear grafts at the most recent postoperative visit. Three eyes underwent LASIK, and 2 eyes had PRK 11 to 17 months after DSAEK. UCVA ranged from 20/80 to 20/200 before refractive surgery (BSCVA: 20/20 to 20/30). Postoperative UCVA improved to 20/20-20/40, and BSCVA was unchanged at 20/20 to 20/30. No patient lost vision. CONCLUSIONS: Refractive error after DSAEK may be safely treated with LASIK or PRK. PRK is equally as effective as LASIK. All grafts remain clear, and all the eyes have significantly improved UCVA.

Epithelial downgrowth after Descemet stripping automated endothelial keratoplasty.

PURPOSE: To report the clinical and histological findings of a single patient who developed late epithelial downgrowth of donor origin after Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: A 70-year-old woman underwent uneventful DSAEK for Fuchs dystrophy in the right eye. The donor had a thickened graft edge for 2 clock hours laterally. She recovered 20/40 vision by 3 months after operation and was maintained on daily prednisolone acetate drops. Three years postoperatively, a routine examination revealed signs of an asymptomatic epithelial downgrowth exhibited by synechiae and ectropion uvea at the area of the thickened donor edge. Six months later, a faint retrocorneal membrane limited to the donor periphery and contiguous with the thick edge was noted. Visual acuity and intraocular pressure remained unchanged. She was followed for the next 15 months, without intervention until the retrocorneal membrane grew centrally, resulting in graft edema. The iris synechiae remained unchanged. Repeat DSAEK, without iridectomy, was performed with confirmation of epithelial downgrowth of donor origin. Six months postoperatively, the patient has done well without sequela of residual downgrowth. RESULTS: Histopathological evaluation showed epithelial downgrowth, emanating from thickened donor edge onto the posterior graft surface. The anterior donor surface (interface) was devoid of downgrowth. X and Y DNA analysis confirmed the downgrowth of male origin (donor) in this female patient. CONCLUSIONS: Donor-derived epithelial downgrowth can occur after DSAEK. Although it can result in graft failure, it behaves much less aggressively than expected and observation may be indicated until symptomatic graft edema occurs. Repeat DSAEK, not penetrating keratoplasty, may be curative.