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    How endothelial cell loss in DSEK compares to PK

    Longer follow-up out to 15 years postoperatively needed

    Indianapolis—Endothelial keratoplasty (EK) has been steadily gaining in popularity over the past decade, and as of 2012, topped the charts, with more EK procedures performed in the United States compared with penetrating keratoplasty (PK).

    Descemet stripping endothelial keratoplasty (DSEK) is the most popular of the EK procedures performed in the United States.

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    An initial evaluation of the DSEK outcomes after 5 years suggested that endothelial cellular loss might be less over the long run than that observed with PK and suggested better midterm endothelial cell survival, Marianne O. Price, PhD, recounted from a 2011 study (Ophthalmology. 2011;118:725-729).

    A more recent single-center, retrospective, longitudinal study, which is forthcoming in Ophthalmology, sought to model DSEK cell loss over 10 years postoperatively and identify factors associated with the cell loss; they compared the findings to cell loss at that same time point in patients who underwent PK in the Cornea Donor Study (Lass JH, et al. Arch Ophthalmol. 2011;129:1149-1154).

    Related: Why infections related to PK require intense vigilance

    Both procedures are indicated to treat patients with Fuchs’ endothelial corneal dystrophy and pseudophakic or aphakic corneal edema.

    The investigators analyzed 752 eyes of 590 patients (age range, 21-96 years) who underwent DSEK, and the data on donor age, and baseline endothelial cell density (ECD) and recipient age, gender, graft indications, and postoperative ECD were studied at 6 ± 3 months, 12 months (-3 to +6 months), and annually from 2 to 10 years, each ± 6-months). All study patients had undergone one or more evaluations between 6 months and 10 years after the surgeries, which were performed by six surgeons. The main outcome measure was the central corneal ECD.

    Related: Techniques for graft outcomes the second time around

    The investigators used the four statistical models of cell loss that were used with the Cornea Donor Study PK data. All four models showed a similar linear decline in ECD from 6 months to 10 years after DSEK.

    Median cell loss

    Lynda Charters
    Lynda Charters is a freelance medical writer.

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