Descemet stripping and endothelial keratoplasty in endothelial dysfunctions: three-month results in 75 eyes

To analyze the results of Descemet stripping and endothelial keratoplasty (DSEK) in the first consecutive 75 cases.

Prospective, non-randomized, non-comparative interventional case series. Seventy-five eyes of 75 patients with endothelial dysfunctions of different etiology, scheduled for DSEK, were included in this study. Healthy donor cornea with a cell count of> 2000 cells/sq mm was considered for transplantation in each case. Indications, operative problems and postoperative complications were noted. Best corrected visual acuity (BCVA), refractive and keratometric astigmatism, central corneal thickness (CCT) and endothelial cell density (ECD) were analyzed for each patient after a minimum follow-up of three months.

Main indication was pseudophakic corneal edema and bullous keratopathy in 53 (70.7%) eyes. Seventeen (22.7%) cases had moderate to severe Fuchs' dystrophy with various grades of cataract; and DSEK was combined with manual small-incision cataract surgery (MSICS) with posterior chamber intraocular lens (PCIOL) in those cases. After three months, BCVA was 20/60 or better in 62 (82.7%) cases. Mean refractive and keratometric astigmatism were 1.10 +/- 0.55 diopter cylinder (DCyl) and 1.24 +/- 0.92 DCyl. The CCT and ECD were 670.8 +/- 0.32 microm and 1485.6 +/- 168.6/sq mm respectively. The mean endothelial cell loss after three months was 26.8 +/- 4.24% (range: 13.3-38.4%). Dislocation of donor lenticule occurred in six (8.0%) eyes. Graft failure occurred in one case.

Descemet stripping and endothelial keratoplasty is a safe and effective procedure in patients with endothelial dysfunctions with encouraging surgical and visual outcomes. It can be safely combined with MSICS with PCIOL in patients with moderate to severe Fuchs' dystrophy with cataract.