Five-Year Graft Survival Comparing Descemet Stripping Automated Endothelial Keratoplasty and Penetrating Keratoplasty.
To compare 5-year graft survival after Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) in Asian eyes.



Prospective, nested, cohort study.



Consecutive patients who underwent DSAEK (423 eyes) or PK (405 eyes) for Fuchs' endothelial dystrophy (FED) or bullous keratopathy (BK).



Clinical data and donor and recipient characteristics were recorded from our prospective cohort from the Singapore Corneal Transplant Registry. All surgeries were performed by the corneal surgeons at our center, which included cases performed or partially performed by corneal fellows in training under direct supervision.



Five-year cumulative graft survival.



Overall mean age was 67.8±9.8 years, and 50.1% of patients were men. There were no significant differences in age (P = 0.261) or gender (P = 0.78) between PK and DSAEK groups in our predominantly Chinese (76.6%) Asian cohort, with more BK compared with FED (68.1% vs. 31.9%; P < 0.001). Overall 5-year graft survival was superior for DSAEK compared with PK (79.4% vs. 66.5%; P < 0.001, log-rank test). Median 5-year percent endothelial cell density loss was significantly greater in PK compared with DSAEK (60.9% vs. 48.7%; P = 0.007). Cox regression analysis revealed that BK was a significant factor associated with graft failure (hazard ratio [HR], 3.30; 95% confidence interval [CI], 2.05-5.33; P < 0.001), and PK was more likely to fail compared with endothelial keratoplasty (HR, 1.61; 95% CI, 1.08-2.41; P = 0.02) adjusting for confounders such as recipient age, gender, and donor factors. Five-year cumulative incidence of complications such as graft rejection (P < 0.001), epitheliopathy (P < 0.001), suture-related corneal infections (P < 0.001), and wound dehiscence (P = 0.002) were greater in the PK group compared with the DSAEK group.



In Asian eyes from the same study cohort with standardized surgical and postoperative regimes, 5-year graft survival was superior for DSAEK compared with PK in eyes with FED and BK.
Singapore National Eye Centre, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore, Republic of Singapore; Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore, Republic of Singapore.
Marcus
M
Ang
Singapore National Eye Centre, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore, Republic of Singapore.
Yuqiang
Y
Soh
Singapore Eye Research Institute, Singapore, Republic of Singapore.
Hla Myint
HM
Htoon
Singapore National Eye Centre, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore, Republic of Singapore; Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore, Republic of Singapore. Electronic address: jodmehta@gmail.com.
Jodhbir S
JS
Mehta
Singapore National Eye Centre, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore, Republic of Singapore; Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore, Republic of Singapore; Department of Ophthalmology, National University Health System, Singapore, Republic of Singapore. Electronic address: donald.tan.t.h@singhealth.com.sg.
Donald
D
Tan
D000368:Aged; D044466:Asian People / Q000208:ethnology; D016022:Case-Control Studies; D002452:Cell Count; D015331:Cohort Studies; D003315:Cornea / Q000502:physiology*; D003316:Corneal Diseases / Q000208:ethnology / Q000601:surgery; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000208:ethnology / Q000601:surgery; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D015994:Incidence; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012846:Singapore; D014019:Tissue Donors; D014792:Visual Acuity