title: Long-term outcomes of penetrating keratoplasty and Descemet stripping endothelial keratoplasty for Fuchs endothelial dystrophy: fellow eye comparison.
abstract: OBJECTIVE
  To compare the visual outcomes and complications after Descemet stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty (PK) in the same set of patients.
  
  
  METHODS
  Fifteen patients underwent PK in 1 eye and DSEK in the fellow eye for Fuchs endothelial dystrophy at the Wills Eye Institute from 1993 to 2011.
  
  
  RESULTS
  Mean postoperative best-corrected visual acuity in the PK and DSEK groups (0.39 ± 0.39 and 0.23 ± 0.12 logarithm of the minimum angle of resolution, respectively) was statistically significantly better than mean preoperative best-corrected visual acuity (0.83 ± 0.36 and 0.76 ± 0.34 logarithm of the minimum angle of resolution, respectively) (P < 0.025 and P < 0.001, respectively). Mean manifest refraction cylinder was higher in the PK eyes than in the DSEK eyes at 1 year [3.58 ± 1.82 and 1.23 ± 1.63 diopter (D), respectively] and at 2 years of follow-up (3.57 ± 1.81 and 1.05 ± 1.18 D, respectively) (P < 0.001) but was not statistically different at the last visit (3.18 ± 2.67 and 1.5 ± 1.66 D, respectively) (P = 0.052). Mean postoperative follow-up was 101.9 ± 39.5 and 29.9 ± 19.9 months after PK and DSEK, respectively. Most common complications after PK were high astigmatism in 15 eyes, monocular diplopia in 7 eyes, posterior capsule opacity in 6 eyes, and secondary glaucoma and graft rejection episodes in 5 eyes each. After DSEK, secondary glaucoma in 3 eyes and graft rejection in 2 eyes were the most common complications.
  
  
  CONCLUSIONS
  Final visual outcomes were not statistically different between the 2 procedures, but DSEK had early visual stabilization and PK had a more complicated course, with more astigmatism, rejections, suture-related infections, and graft failures.
authors: Cornea Service, Wills Eye Institute, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors: Mustafa
authors: M
authors: Kosker
authors: Kunal
authors: K
authors: Suri
authors: Fulya
authors: F
authors: Duman
authors: Kristin M
authors: KM
authors: Hammersmith
authors: Parveen K
authors: PK
authors: Nagra
authors: Christopher J
authors: CJ
authors: Rapuano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D057111:Descemet Stripping Endothelial Keratoplasty / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity