title: Rate of Rejection After Descemet Stripping Automated Endothelial Keratoplasty in Fuchs Dystrophy: Three-Year Follow-up.
abstract: OBJECTIVE
  To evaluate the rate of rejection after Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with Fuchs endothelial dystrophy (ED) and to analyze potential risk factors for rejection.
  
  
  METHODS
  An observational retrospective chart review of 400 patients with Fuchs ED was performed. The primary outcome was the rate of endothelial graft rejection. Secondary outcomes included graft clarity after rejection, medications at the time of rejection, and preoperative graft thickness.
  
  
  RESULTS
  A total of 400 consecutive eyes with at least 1 year of follow-up were evaluated with an average follow-up of 38 months (range 12-95 months). The cumulative rate of rejection at 1 year was 1%; 2 years, 2.9%; and 3 years, 4.8%. The greatest number of rejection episodes occurred between postoperative months 19 and 30 (N = 7). There was a statistically significant association of developing a rejection episode when a patient was off of topical steroids (P = 0.001, odds ratio = 6.25, 95% confidence interval = 2.03-19.3) or had a donor graft thickness greater than 145 μm (P = 0.011, odds ratio = 5.03, 95% confidence interval, 1.28-23.1).
  
  
  CONCLUSIONS
  Corneal graft rejection is an uncommon but important complication after DSAEK. This study reports a lower rejection rate in Fuchs ED than that reported in previous studies. Risk factors for developing a rejection episode include discontinuation of topical steroids and a graft thickness greater than 145 μm. Maintaining patients on indefinite topical corticosteroid therapy and using thinner donor tissue will likely result in an even lower rate of rejection.
authors.affiliation: *Cincinnati Eye Institute, Cincinnati, OH;†University of Cincinnati, Cincinnati, OH;‡Cole Eye Institute, Cleveland, OH;§SouthEast Eye Specialist, Chattanooga, TN; and¶Eye Consultants of Atlanta, Atlanta, GA.
authors.forename: Lorena
authors.initials: L
authors.lastname: Sepsakos
authors.forename: Kevin
authors.initials: K
authors.lastname: Shah
authors.forename: T Peter
authors.initials: TP
authors.lastname: Lindquist
authors.forename: William Barry
authors.initials: WB
authors.lastname: Lee
authors.forename: Edward
authors.initials: E
authors.lastname: Holland
mesh_terms: D000368:Aged; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology