Authors (including presenting author) :
Wu ACL(1)(2)(3), Kam KW(1)(2)(3), Mok E(1)(2)(3), Kwok SHW(1)(2)(3), Young AL(1)(2)(3)
Affiliation :
(1) Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, (2) Department of Ophthalmology and Visual Sciences, Alice Ho Miu Ling Nethersole Hospital, (3) Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
Keyword 1: :
Keratoplasty
Keyword 2: :
Endothelial keratoplasty
Keyword 3: :
Penetrating keratoplasty
Keyword 4: :
Fuchs endothelial dystrophy
Keyword 5: :
Pseudophakic bullous keratoplasty
Introduction :
Keratoplasty is the definitive treatment for eyes with irreversible corneal oedema secondary to the loss of corneal endothelium. In recent decades, endothelial keratoplasty (EK) has risen in dominance because of smaller wounds, faster visual recovery, less surgically-induced astigmatism and often superior visual outcomes compared to penetrating keratoplasty (PKP). However, EK carries a steep learning curve especially in Asian eyes with narrow anterior chambers. Recent systemic reviews have suggested a trend towards better 5-year graft survival after EK compared to PKP, as well as superior best-corrected visual acuity (BCVA). However, there is a lack of comparative data at 10 years in the literature.
Objectives :
To compare the long-term survival of primary EK versus PKP in Hong Kong patients with Fuchs endothelial dystrophy (FED) or pseudophakic bullous keratoplasty (PBK).
Methodology :
A ten-year retrospective cohort of patients who received primary Descemet stripping endothelial keratoplasty (DSEK) or PKP for either FED or PBK at an academic ophthalmology department in Hong Kong between 2006 and 2015 was conducted.
Result & Outcome :
Seventy-four eyes of 65 patients received primary keratoplasties with a mean follow-up of 95 months, comprising 40 DSEK and 34 PKP. Overall graft survival rates were 76.1% at 5 years and 55.0% at 10 years. DSEK demonstrated higher survival rates than PKP, with 81.7% versus 69.0% survival at 5 years (p=0.35) and 63.5% versus 43.6% at 10 years (p=0.16). Older age was a predictive factor for graft failure. Postoperative BCVA was significantly better for DSEK at 5 years (p=0.006). Graft ulcers occurred in fewer eyes receiving DSEK (5.0%) compared to PKP (20.6%) at 10 years (p=0.04). The cumulative rejection rates were 12.5% for DSEK and 8.8% for PKP at 10 years (p=0.61) while 15.0% of DSEK and 11.8% of PKP required a re-graft (p=0.69). Both primary DSEK and PKP yielded satisfactory survival outcomes among Hong Kong patients with FED or PBK. Older age predicted a worse graft survival. Patients undergoing DSEK experienced superior BCVA at 5 years and a lower risk of graft ulcers at 10 years. DSEK and PKP had similar rejection and re-graft rates under close monitoring and timely management.
