*Correspondence – Lana Fu: L.Fu@nhs.net
Objective To compare endothelial cell loss, graft survival, and clinical outcomes in patients with Fuchs’ endothelial dystrophy (FED) up to 5 years after Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK).
Methods 318 consecutive DSEK (n=189) and DMEK (n=129) grafts of 223 patients performed by 8 surgeons with standardised protocols between January 2006 and October 2021 were analysed. Group differences were compared with parametric and non-parametric tests. Kaplan-Meier analysis and Cox regression were conducted for graft survival and identify graft failure and rejection risk factors.
Results At 5 years, graft survival was 97% and 98% (p=0.370) in DSEK and DMEK eyes. Mean percentage endothelial cell loss was 56.6±17.6 in DSEK and 55.6±15.2 in DMEK eyes (p=0.865). Mean BSCVA was 0.12±0.13 LogMAR in DSEK and 0.00±0.17 in DMEK grafts (p<0.00001) at 5 years postop. Within 5 years, 12% of DSEK and 9% of DMEK eyes developed allograft rejection (p=0.412). Rebubbling was performed in 9.0% of DSEK and 2.3% of DMEK grafts (p=0.211). Cox regression identified rejection episode (HR 1.36; 95% CI: 2.31–80.22 (p=0.004)) as a significant contributing factor for graft failure.
Conclusions At 5 years there was no significant difference in graft survival or endothelial cell loss between DMEK and DSEK eyes with FED. We propose that our standardised technique reduces the need for rebubbling. DMEK had superior visual acuity outcomes compared with DSEK in these patients up to 5 years after surgery.
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