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Long-term Outcomes of Penetrating Keratoplasty and Descemet Stripping Endothelial Keratoplasty for Fuchs Endothelial Dystrophy: Fellow Eye Comparison

Kosker, Mustafa MD; Suri, Kunal MD; Duman, Fulya MD; Hammersmith, Kristin M. MD; Nagra, Parveen K. MD; Rapuano, Christopher J. MD

doi: 10.1097/ICO.0b013e31828ea02a
Clinical Science

Purpose: To compare the visual outcomes and complications after Descemet stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty (PK) in the same set of patients.

Methods: Fifteen patients underwent PK in 1 eye and DSEK in the fellow eye for Fuchs endothelial dystrophy at the Wills Eye Institute from 1993 to 2011.

Results: Mean postoperative best-corrected visual acuity in the PK and DSEK groups (0.39 ± 0.39 and 0.23 ± 0.12 logarithm of the minimum angle of resolution, respectively) was statistically significantly better than mean preoperative best-corrected visual acuity (0.83 ± 0.36 and 0.76 ± 0.34 logarithm of the minimum angle of resolution, respectively) (P < 0.025 and P < 0.001, respectively). Mean manifest refraction cylinder was higher in the PK eyes than in the DSEK eyes at 1 year [3.58 ± 1.82 and 1.23 ± 1.63 diopter (D), respectively] and at 2 years of follow-up (3.57 ± 1.81 and 1.05 ± 1.18 D, respectively) (P < 0.001) but was not statistically different at the last visit (3.18 ± 2.67 and 1.5 ± 1.66 D, respectively) (P = 0.052). Mean postoperative follow-up was 101.9 ± 39.5 and 29.9 ± 19.9 months after PK and DSEK, respectively. Most common complications after PK were high astigmatism in 15 eyes, monocular diplopia in 7 eyes, posterior capsule opacity in 6 eyes, and secondary glaucoma and graft rejection episodes in 5 eyes each. After DSEK, secondary glaucoma in 3 eyes and graft rejection in 2 eyes were the most common complications.

Conclusions: Final visual outcomes were not statistically different between the 2 procedures, but DSEK had early visual stabilization and PK had a more complicated course, with more astigmatism, rejections, suture-related infections, and graft failures.

Supplemental Digital Content is Available in the Text.

Cornea Service, Wills Eye Institute, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.

Correspondence: Christopher J. Rapuano, Wills Eye Institute, Suite 920, 840 Walnut St, Philadelphia, PA 19107 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Received January 16, 2013

Accepted February 21, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.