Comparative observation of the efficacy of simplified Descemet stripping endothelial keratoplasty and penetrating keratoplasty in treating bullous keratopathy

Abstract

The aim of the present study was to compare the clinical efficacy between simplified Descemet stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty (PKP) in the treatment of patients with bullous keratopathy (BK). A cohort of 65 patients (65 eyes) with BK recruited between December 2002 and June 2018 was divided into two groups according to the treatment they received: The simplified DSEK group (n=38) and the PKP group (n=27). The best-corrected visual acuity (BCVA) during the follow-up at 1, 3, 6 and 12 months and postoperative complications were all recorded. Furthermore, the graft survival rate after 1 year was recorded. The mean BCVA in the simplified DSEK group was significantly better than that in the PKP group after 1, 3, 6 and 12 months (P<0.05). Furthermore, the 1-year graft survival rate in the simplified DSEK group (91.2%) was significantly higher than that in the PKP group (70.4%; P= 0.039). A total of 13 eyes (34.21%) in the simplified DSEK group and 11 eyes (40.74%) in the PKP group were diagnosed with glaucoma; there was no significant difference between the rate of glaucoma diagnosis between the two groups (P=0.591). Graft rejection was observed in 5 eyes (13.16%) of the simplified DSEK group and 8 eyes (29.63%) of the PKP group and the rate of graft rejection did not differ significantly between the groups (P= 0.279). Graft infection occurred in 1 eye (2.63%) in the simplified DSEK group and 6 eyes (22.22%) in the PKP group. Simplified DSEK achieved better visual acuity and longer graft survival rates than PKP. The incidence of postoperative secondary glaucoma, graft rejection and graft infection after simplified DSEK was lower than that in the PKP group, but only the incidence of graft infection was significantly different.

Descemet membrane endothelial keratoplasty and penetrating keratoplasty in pseudophakic bullous keratopathy: comparison of visual outcomes, graft survival rates, and complications

“…Studies on the effectiveness of PK [7] and EK [6,8] after BK have been previously conducted. However, studies comparing the surgical results of PK and EK in PBK are lim- [9][10][11]. In these studies, PK and Descemet…”

The effect of loteprednol suspension eye drops after corneal transplantation

“…The PKP procedure was described in our previous study [14]. Briefly, a suitable trephine was selected to clockwise rotate into the cornea to drill the graft bed.…”

Impact of vaccination on keratoplasty

“…High-risk PKPs are classically defined as transplants performed in eyes with corneal neovascularization, a history of graft failure, or uncontrolled glaucoma but the definition varies across studies [133,139]. High-risk PKPs have rejection rates up to 60% despite measures, such as systemic immunosuppression [67 ▪ ,75 ▪ ,82 ▪ ,133,138 ▪▪ ,140 ▪▪ ,141,142 ▪ ]. Although some risk factor studies report contradictory findings and risk factor assessment can be complicated by confounding factors, multiple recipient factors are associated with a higher rejection risk (Table 3) [35,53,132,133].…”

“…In penetrating keratoplasty (PKP), the full-thickness cornea is transplanted to the recipient and rejection may occur in any of the corneal layers. Rejection rates for low to intermediate-risk PKP range from 4 to 35.6% with up to 25 years of follow-up [35,44,45,46 ▪ ,47–53,54 ▪ ,55–63,64 ▪ ,65,66,67 ▪ ,68–74,75 ▪ ]. The range of published rejection rates at specific times-since-transplant are reported in Table 2.…”

“…Descemet's stripping endothelial keratoplasty (DSEK) involves transplantation of the endothelial, Descemet's membrane, and inner stromal layers [35]. Rejection rates range from 0 to 20.7% with up to 10 years of follow-up (Table 2) [38,47,49,55,59,64 ▪ ,67 ▪ ,85 ▪ ,86 ▪ ,87 ▪ ,88–93,95–99,100 ▪ –106 ▪ ,107]. Whether or not rejection rates plateau after 3 years largely depends on continued topical corticosteroid usage [38,47,59,90,92,93,95,96,103 ▪ ,133,146].…”