Graft rejection and failure following endothelial keratoplasty (DSAEK) and penetrating keratoplasty for secondary endothelial failure.

PURPOSE: To compare the frequency of rejection and graft failure after Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) for secondary endothelial failure.

METHODS

Seventy-eight eyes undergoing DSAEK from 2006 to 2013 and 80 eyes undergoing PK from 1998 to 2013 were included. Indications were endothelial failure due to pseudophakic bullous keratopathy (82%), previous eye trauma (8%), uveitis (4%) or other causes (6%). Rejection episodes and graft failure were recorded, together with preoperative risk factors (glaucoma, neovascularization and active inflammation). Kaplan-Meier survival curves with up to 4 years follow-up were used to compare DSAEK with PK, as well as low-risk with high-risk eyes.

RESULTS

During follow-up, 15% of the PK-treated eyes and 4% of the DSAEK-treated eyes experienced rejection. Graft failure occurred in 8% of the PK-treated eyes and in 7% of the DSAEK-treated eyes. No significant differences were found in the rate of rejection (p=0.11), graft failure (p=0.29) or rejection-related graft failure (p=0.30) between DSAEK and PK in low-risk eyes. In DSAEK, high-risk eyes (mainly with glaucoma) experienced significantly more rejection episodes (p=0.01), graft failures (p=0.04) and rejection-related graft failures (p=0.04) compared with low-risk eyes. No differences were seen between high-risk and low-risk PK-treated eyes (p>0.40).

CONCLUSION

In the present, relatively small study, no differences in rejection rate or graft failure were found between DSAEK and PK in low-risk eyes. However, glaucoma seems to increase the risk of graft complications after DSAEK for secondary endothelial failure. Long-term studies of larger samples sizes are needed to confirm this.