ESCRS - PO525 - Long-Term Outcomes Of Descemet Stripping Automated Endothelial Keratoplasty Transplants: A Decade Of Patient Recruitment And 4 Years Follow-Up

Long-Term Outcomes Of Descemet Stripping Automated Endothelial Keratoplasty Transplants: A Decade Of Patient Recruitment And 4 Years Follow-Up

Published 2025 - 43rd Congress of the ESCRS

Reference: PO525 | Type: Free paper | DOI: 10.82333/zq6m-kq08

Authors: Ali Ceylan* 1 , Omer Faruk Peker 2 , Fahri Onur Aydin 1 , Yusuf Berk Akbas 1 , Burcin Kepez Yildiz 1

1Ophthalmology,Basaksehir Cam and Sakura City Hospital ,Istanbul,Türkiye, 2ophthalmology,Basaksehir Cam and Sakura City Hospital ,Istanbul,Türkiye

Purpose

To assess long-term outcomes in terms of best corrected visual acuity (BCVA) and graft survival of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) transplants performed over a 10-year period.

Setting

A single-centre retrospective cohort study conducted at Hospital Universitari Germans Trias i Pujol, Barcelona, analyzing patient records from January 2008 to January 2018, with 4 years of follow-up or else until February 2020.

Methods

We reviewed DSAEK procedures performed during the 10-year recruitment period and included following data: Age, sex, laterality, primary diagnoses, lens status, need for rebubbling, graft failure, BCVA and endothelial cell count (ECC) at baseline, 1, 3, 6, 12, 24, 36 and 48 months. Inclusion criteria were: patients over 18 years old and follow up for at least 6 months. Exclusion criteria were: infection and graft rejection. To address missing data, we applied the Last Observation Carried Forward (LOCF) approach. A Kaplan-Meier survival curve was constructed to analyze graft survival. R-studio software was used for descriptive analysis.

Results

A total of 293 DSAEK transplants were included, from 254 different eyes (39 retransplants), comprising 238 patients (16 bilateral). The mean age of the cohort was 70.5 years (SD±10.8). Female patients accounted for 169 cases (57.7%). DSAEK was performed on the right eye in 50.5%. Fuchs’ dystrophy was the diagnosis in 143 patients (48.8%). 155 patients (52.9%) were pseudophakic and 4 (1.37%) aphakic. Graft failure with indication of reDSAEK happened in 45 cases (15.4%). Rebubbling was needed in 38 cases (13%). Mean donor ECC was 2734 cells (SD±361). Mean ECC loss at 4 years was 953 cells (SD±595). Mean BCVA gain at 4 years was 0.21 (SD±0.27). Overall graft survival rates were 95% at 5 months, 90% at 22 months and 70% at 48 months.

Conclusions

This study provides strong evidence on DSAEK’s long-term efficacy, demonstrating sustained BCVA improvement and long graft survival in a large cohort with extended follow-up. Further research is needed to identify factors associated with higher survival rates and greater BCVA gain.