Purpose: To compare the visual outcomes and complications rate after penetrating keratoplasty (PKP) and Descemet stripping automated endothelial keratoplasty (DSAEK), in the fellow eye of the same subjects, and to evaluate the patient's perspective on these operations.
Methods: A retrospective cohort study was undertaken in the Cornea Clinic at the Toronto Western Hospital. We reviewed the records of 12 patients (24 eyes) who underwent PKP in one eye and DSAEK surgery in their fellow eye. Patient's satisfaction for both procedures was evaluated using a subjective questionnaire. These techniques were compared for intraoperative and postoperative complications and visual and refractive outcomes including contrast acuity, contrast threshold, and high-order ocular aberrations (HOA).
Results: All the patients in this study preferred the DSAEK operation. They reported faster recovery time [1.5 week in the DSAEK vs 5.3 weeks in the PKP operation (P = 0.01)], significantly less pain, and better visual outcomes with the DSAEK operation. Uncorrected visual acuity and best-corrected visual acuity were significantly better in the DSAEK operated eyes. The DSAEK surgery was associated with significantly less astigmatism (P = 0.0003) and ametropia. Contrast acuity was significantly better in the eye that underwent DSAEK procedure (P < 0.05), whereas contrast threshold was better in the PKP eye. The PKP operated eyes demonstrated increased level of HOA.
Conclusions: Patients preferred the DSAEK operation compared with PKP. Better uncorrected visual acuity, best-corrected visual acuity, and contrast acuity together with avoidance of surgery-induced astigmatism and HOA are the main benefits of the DSAEK technique.