Endothelial cell counts after Descemet's stripping automated endothelial keratoplasty versus penetrating keratoplasty in Asian eyes

Background: The purpose of this study was to compare endothelial cell counts after Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty in Asian eyes. Methods: This was a retrospective study of patients from our prospective Singapore Corneal Transplant Study cohort who received corneal transplantation in 2006-2008. We compared eyes that underwent DSAEK or penetrating keratoplasty for Fuchs' endothelial dystrophy or pseudophakic and aphakic bullous keratopathy. Clinical data, and donor and recipient characteristics were recorded. Of 241 patients who met our inclusion criteria, 68 underwent DSAEK and 173 underwent penetrating keratoplasty. The main outcome measure was endothelial cell loss at 1 year. Secondary outcome measures were graft survival and visual outcomes at 1-year follow-up. Results: There were no significant differences in baseline characteristics of patients between the treatment groups. Percent endothelial cell loss at 1-year follow-up was greater in penetrating keratoplasty eyes (40.9% +/- 2.9%) compared with DSAEK eyes (22.4% +/- 2.3%; P < 0.001). DSAEK-treated eyes had significantly superior uncorrected visual acuity (mean difference = 0.42 +/- 0.0059; P < 0.001) and best spectacle-corrected visual acuity (mean difference = 0.14 +/- 0.032; P < 0.001) as compared with penetrating keratoplasty-treated eyes. Penetrating keratoplasty-treated eyes had worse astigmatism as compared with DSAEK-treated eyes (-3.0 +/- 2.1 versus -1.7 +/- 0.8; P < 0.001). Graft survival at 1 year was comparable in both groups, ie, 66/68 (97.0%) DSAEK-treated eyes versus 158/173 (92.0%) of penetrating keratoplasty-treated eyes had clear grafts (P = 0.479). Conclusion: We report lower percent endothelial cell loss comparing DSAEK and penetrating keratoplasty at 1-year follow-up in Asian eyes, with comparable graft survival rates in both groups.