Purpose: To evaluate the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in 78 eyes with corneal endothelial dysfunction performed by cornea fellows under the supervision of experienced faculty members in an academic hospital.
Methods: In this interventional case series, 78 eyes of 73 patients with corneal endothelial dysfunction of different underlying etiologies were enrolled for DSAEK. Healthy donor corneas with more than 2000 endothelial cells per square millimeter were requested. Intraoperative and postoperative complications were recorded. Best-corrected visual acuity, postoperative refraction, central corneal thickness, and endothelial cell density at 6 months after surgery were also registered and analyzed.
Results: Among 78 eyes of 73 patients with corneal endothelial dysfunction, DSAEK was performed on 55 eyes (70.5%) due to pseudophakic bullous keratopathy, which was the most common indication. Other indications included aphakic bullous keratopathy in 6 (7.7%), Fuchs endothelial dystrophy in 7 (8.9%), failed penetrating keratoplasty in 5 (6.4%), failed DSAEK in 3 (3.8%), and congenital hereditary endothelial dystrophy in 2 eyes (2.6%). All operations were performed by 4 cornea fellows supervised by the faculty members. Mean preoperative best-corrected visual acuity was 1.8 LogMAR, which improved to 0.77 LogMAR 6 months after the surgery. At this time, the mean central corneal thickness was 709.09 ± 109.24 μm and mean 6-month postoperative endothelial cell density was 1180 cells per square millimeter representing a mean cell loss of 61%, and mean spherical equivalent was +0.53 ± 1.83 diopter. Lenticule detachment was observed in 17 eyes (21.8%). Graft failure occurred in 8 eyes (10.2%).
Conclusions: Outcomes of DSAEK performed by cornea fellows supervised by the faculty members seems to be fairly acceptable.