Long-Term Endothelial Outcomes and Dislocation Risks in Small Versus Large Grafts for Descemet's Stripping...

Area of Science:

• Ophthalmology
• Corneal Surgery
• Endothelial Keratoplasty

Background:

• Bullous keratopathy (BK) is a condition affecting corneal health.
• Descemet's stripping endothelial keratoplasty (DSEK) is a surgical option for BK.
• Graft size selection in DSEK may influence clinical outcomes.

Purpose of the Study:

• To compare clinical outcomes of small-graft versus large-graft DSEK in BK patients.
• To evaluate the impact of graft diameter on endothelial cell survival and complications.

Main Methods:

• Retrospective comparative study of 62 BK patients undergoing DSEK.
• Patients divided into small-graft (7.0-8.0 mm) and large-graft (8.0-9.0 mm) groups.
• Evaluated best-corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss (ECL) rate, graft transparency, and complications at 1, 3, 6, and 12 months.

Main Results:

• Large grafts showed a significantly lower ECL rate at 12 months (20.07% vs 24.34%).
• BCVA improvement and graft transparency were comparable between groups.
• Large grafts had a higher incidence of graft dislocation (32.35% vs 10.71%), while secondary glaucoma and rejection rates were similar.

Conclusions:

• Larger DSEK grafts improve long-term endothelial cell preservation in BK patients.
• However, larger grafts are associated with an increased risk of graft dislocation.
• Individualized graft size selection is recommended, balancing endothelial survival benefits against dislocation risks.