Descemet Stripping Automated Endothelial Keratoplasty in Pseudophakic Bullous Keratoplathy versus Fuch's Endothelial Dystrophy

To compare clinical and confocal scan outcomes after Descemet stripping automated endothelial keratoplasty (DSAEK) performed for Fuchs’ endothelial dystrophy versus pseudophakic bullous keratopathy. In this retrospective comparative study, 47 consecutive eyes of 39 patients with the diagnosis of Fuchs’ endothelial dystrophy (n=29, group 1) or pseudophakic bullous keratopathy (n=18, group 2) that underwent DSAEK were enrolled. Postoperatively, confocal microscopy was used to measure central corneal and graft thickness and endothelial cell density and morphology. Postoperative visual acuity, refractive outcomes, graft endothelial cell count, central corneal and graft thickness, and postoperative complications were compared between the study groups. Mean age at the time of surgery were 65.2±11.8 and 69.4±12.5 years in groups 1 and 2, respectively (P=0.27). Follow-up period were 23.6±14.0 months in group 1 and 25.6±15.7 months in group 2 (P=0.79). Postoperative best spectacle-corrected visual acuity was significantly better in group 1 than in group 2 in 6 months after surgery. Afterwards, the two study groups were comparable in this regard. Postoperative spherical equivalent refractive error was +0.39±1.46 D in group 1 and +0.80±1.47 D in group 2 (P=0.45). Postoperative refractive astigmatism was 1.02±0.83 D and 2.36±0.67 D, respectively (P<0.001). Mean central graft thickness was 98.0±33.3 µm in group 1 and 107.6±28.0 µm in group 2 (P=0.45). No significant statistically difference was observed between two groups in postoperative endothelial cell density. Outcomes of DSAEK surgery were comparable between Fuchs’ endothelial dystrophy and pseudophakic bullous keratopathy. All grafts were clear despite lower than normal endothelial cell counts.