DSAEK for the treatment of endothelial disease: Results in the initial 100 cases

Purpose: To evaluate the learning curve and the outcome of Descemet Automated Endothelial Keratoplasty (DSAEK) in patients with primary or secondary endothelial decompensation. Methods: DSAEK was performed in 100 eyes with endothelial decompensation (Fuchs Dystrophy n = 59; pseudophakic bullous keratopathy n = 33; failed corneal graft n = 8). All patients underwent a standard procedure including the following steps: Descemet membrane and endothelium removal from the recipient cornea under air; inferior peripheral iridectomy; microkeratome-assisted preparation of a donor lamella consisting of deep stroma and endothelium (between 100 and 200 micron in thickness), which is punched to desired size (8.5 to 9 mm) from the endothelial side; graft delivery with a specially designed glide; complete anterior chamber air fill to obtain firm attachment of the donor lamella and air-tight closure of all surgical wounds. In 46 cases phacoemulsification with implantation of an intraocular lens into the capsular bag was combined with DSAEK surgery. Visual acuity, refraction and endothelial cell count were evaluated prospectively at 1, 3, 6, and 12 months after DSAEK. Results: As early as 1 month after surgery 76 of 100 patients had a best spectacle-corrected visual acuity (BSCVA) better than or equal to 0.5, with a refractive astigmatism within 1.5 Diopters (D). One year after surgery, 79 of 100 patients had a BSCVA better than or equal to 0.5, with a refractive astigmatism within 1.5 D. At this examination time 11 of 100 patients could see 1.0 or better and the average endothelial cell loss amounted to 22.5 ± 4.2 %. Conclusions: DSAEK surgery allows fast visual rehabilitation of patients with decompensated endothelium. Visual outcome is superior to that of conventional penetrating keratoplasty (PK) in terms of BSCVA and early stabilization. Endothelial cell loss also compares favourably to that recorded after PK.