Long-Term Outcomes Of Dsaek At A Tertiary Eye Center In Saudi Arabia: A 15-Year Retrospective Review

This study aims to evaluate the long-term outcomes of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) at a tertiary care center in Saudi Arabia over a 15-year period, focusing on the graft survival, visual improvement, complications rates, and graft insertion techniques.

Single-center retrospective review conducted at King Abdulaziz University Hospital (tertiary eye center), Riyadh, Saudi Arabia.

This is a retrospective study that included all patients who underwent DSAEK at King Abdulaziz University Hospital (KAUH), Riyadh, between 2009 and 2024. Data were collected on demographics, surgical details, visual acuity, graft survival, and complications. Primary and secondary graft failures were clarified, and risk factors were analyzed using univariate and multivariate Cox regression. Kaplan-Meier survival curves were used to represent the grafts survival, and surgical techniques (Lens Glide vs. Busin Glide) were compared.

A total of 179 eyes were included. The overall graft survival rate was 69.3%,with cumulative survival of 81.0%at 1 year,63.8%at 3 years,and 51.7%at 5 years. Visual acuity improved in 46.9% of patients. Postoperative complications occurred in 38.5% of cases, with endothelial rejection being the leading cause of graft failure.In multivariate analysis, postoperative complications were the only independent risk factor for failure(HR = 2.67,95% CI:1.71–4.18,p <0.001).Although not statistically significant,a trend toward decreasing survival rates was evident with repeated DSAEK. Among surgical techniques, the lens glide group had no primary failures in the single-surgeon subgroup and demonstrated higher success rates than busin glide(p = 0.026).

DSAEK provides favorable long-term outcomes, though prior surgeries, glaucoma, and postoperative complications, specifically endothelial rejection, can negatively impact graft survival. Surgical technique may influence early failure rates, emphasizing the importance of gentle tissue handling and surgeon expertise.