Descemet Stripping Endothelial Keratoplasty for Fuchs' Endothelial Corneal Dystrophy: Five-Year Results of a Prospective Study.
OBJECTIVE
To determine 5-year outcomes of Descemet stripping endothelial keratoplasty (DSEK) for Fuchs' endothelial corneal dystrophy (FECD).


METHODS
Prospective cohort study.


METHODS
Fifty-two eyes of 45 subjects with FECD undergoing primary DSEK.


METHODS
Subjects were examined before and at fixed intervals through 60 months after DSEK. At each visit, graft survival was determined by slit-lamp examination; best spectacle-corrected visual acuity (BSCVA) was measured using the electronic Early Treatment Diabetic Retinopathy Study (ETDRS) protocol; total anterior corneal higher-order aberrations (HOAs) were derived from corneal topography; and corneal backscatter, corneal thickness, and endothelial cell density were measured from confocal microscopy images. Corneal thickness also was measured by ultrasonic pachymetry. Changes after DSEK were analyzed using generalized estimating equation models.


METHODS
Best-corrected visual acuity, HOAs, endothelial cell loss, corneal thickness, and corneal backscatter.


RESULTS
Complete 60-month follow-up was possible in 34 eyes. Mean BSCVA±standard deviation improved from 0.45±0.19 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent, 20/56) before DSEK to 0.09±0.13 logMAR (Snellen equivalent, 20/25) at 5 years (P < 0.001). Between 1 and 5 years, BSCVA improved by 0.06 logMAR (or 3 ETDRS letters; 95% confidence interval, 0.05-0.07 logMAR) per year (P < 0.001), and 56% of eyes were 0.1 logMAR (20/25) or better at 5 years. Graft thickness (approximately 155 μm) and corneal thickness (approximately 700 μm) did not change after surgery. Anterior corneal HOAs and backscatter decreased between 1 and 5 years (P ≤ 0.002). Six grafts failed, of which 4 were primary (iatrogenic); mean endothelial cell loss±standard deviation was 55±15% at 5 years.


CONCLUSIONS
Between 1 and 5 years after DSEK, BSCVA continues to improve such that at 5 years, more than half of eyes see better than 20/25 with a mean total corneal thickness of 700 μm. Improvement in vision is accompanied by continued reduction in corneal haze and aberrations, suggesting ongoing remodeling of the cornea after restoration of endothelial function.
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
Katrin
K
Wacker
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
Keith H
KH
Baratz
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
Leo J
LJ
Maguire
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
Jay W
JW
McLaren
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota. Electronic address: patel.sanjay@mayo.edu.
Sanjay V
SV
Patel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000473:pathology* / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity