To describe 10-year outcomes for graft and endothelial cell survival after Descemet stripping endothelial keratoplasty (DSEK), including risk factors for graft failure.
Retrospective clinical cohort study.
356 consecutive DSEK grafts performed by 10 surgeons using a standardized protocol were analyzed. Primary outcomes were cumulative graft survival and percentage endothelial cell loss (ECL) from 6 months to 10 years; secondary outcomes included risk factors for graft failure, postoperative complications, visual outcomes, and central corneal thickness.
Indications include Fuchs’ endothelial dystrophy (n=209), bullous keratopathy (n=88), and previous graft failure (n=39). 104 eyes (29%) had preoperative glaucoma. Cumulative graft survival of all eyes at 1, 3, 5, and 10 years were 97%, 90%, 85%, and 79%. 10-year graft survival for Fuchs’ endothelial dystrophy was 92%. Percentage ECL of all grafts were 46.6 ± 17.3 at year 1, 54.9 ± 18.7 at year 3, 59.6 ± 17.4 at year 5, and 73.1 ± 9.7 at year 10. Cox regression identified preoperative glaucoma (HR 8.41, 95% CI, 1.30-54.5, P= 0.026), including previous glaucoma surgery (HR 3.63, 95% CI, 1.03-12.74, P=0.04), and regrafts (HR 5.29, 95% CI, 2.02-13.89, P=0.001) as significant risk factors for graft failure.
At 10 years, DSEK survival rate was 79% for all eyes, including complex grafts, and ECL was 73%. For FED, 10-year graft survival was 92%. Despite a mean 10-year endothelial cell count of only 692 cells/mm, graft survival remained high with good vision. DSEK continues to be a viable treatment option, especially in complex eyes with comorbidity.

Copyright © 2021. Published by Elsevier Inc.

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