Over long term, DSEK and PK have similar cumulative endothelial cell loss but different patterns of loss
COPENHAGEN — A 10-year comparison of cell loss after penetrating keratoplasty and Descemet’s stripping endothelial keratoplasty showed a similar cumulative loss but different cell loss patterns.
“We had previously evaluated the 5-year endothelial cell decline in both DSEK and DMEK and were pleased to find that the rate of decline was slower in the first 5 years as compared with PK,” Marianne Price, PhD, said at the EuCornea meeting.
“To assess the 10-year cell decline, we retrospectively reviewed the data collected on our first 1,005 DSEK cases,” she said.
Data analysis showed that endothelial cell density declined at essentially a linear rate of about 110 cells/mm2/year between 6 months and 10 years after DSEK, leading to a mean cumulative loss of 71%, only 5% lower that the cumulative loss with PK.
However, cell loss patterns differed. PK showed a more rapid decline up to 5 years, with a cumulative 17% cell loss, followed by stable, slower decline. DSEK, on the other hand, had a higher perioperative cell loss reaching 32% at 6 months. The 6-month cell loss strongly correlated with cell density at 10 years.
“This suggests that it is important to utilize surgical techniques that minimize endothelial damage,” Price said.
In DSEK, the 10-year cell density was not correlated with the donor cell density, suggesting that surgeons can be reasonably flexible with the cell count they ask for from eye banks, Price said.
Prior glaucoma surgery was the biggest risk factor for accelerated cell loss and graft failure. – by Michela Cimberle
Price M. Ten year endothelial cell loss with DSEK compared with penetrating keratoplasty in the cornea donor study. Presented at EuCornea; Sept 9-10, 2016; Copenhagen, Denmark.
Disclosure: Price reports no relevant financial disclosures.