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Ten-year outcomes in corneal transplantation techniques have yielded important insights to help us advise individuals with Fuchs endothelial corneal dystrophy who are considering surgery. Surprisingly, penetrating keratoplasty (PK) demonstrated superior 10-year graft survival rates (92%) compared to Descemet membrane endothelial keratoplasty (DMEK, 75%) and Descemet stripping automated endothelial keratoplasty (DSAEK, 73%).
Endothelial keratoplasty techniques showed advantages in terms of other outcomes. DMEK had the lowest rejection rate at 10%, compared to 13% for PK and 19% for DSAEK. Visual recovery was significantly faster with DMEK and DSAEK, with individuals achieving driving vision in a median of 7.8 and 12.4 months respectively, versus 37.9 months for PK. However, endothelial cell density loss was more rapid in DMEK and DSAEK compared to PK.
When speaking with our patients, we need to understand these outcomes and consider the possible need for repeat procedures in endothelial keratoplasty against slower visual recovery and potentially higher astigmatism with PK. This information highlights and is a reminder for us to take a personalized management approach based on individual needs and preferences.
-JRM
Go to article in Nature Eye: HERE
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