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Outcomes of Descemet Stripping Automated Endothelial Keratoplasty


Key Concepts

  • Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK) provides rapid visual recovery.

  • Postoperative complications can be minimized with careful intraoperative technique.

  • DSEK/DSAEK yields 20/25–20/30 vision 1–3 years after surgery.

  • DSEK/DSAEK causes minimal refractive change.

  • DSEK/DSAEK maintains a physiologic corneal surface with minimal change in astigmatism.

  • Endothelial cell loss following DSEK/DSAEK compares favorably with penetrating keratoplasty over the medium- to long-term.

Introduction

Endothelial keratoplasty (EK) has evolved dramatically over the past 15 years from the initial posterior lamellar keratoplasty (PLK) cases described by Melles et al. and the deep lamellar endothelial keratoplasty (DLEK) series described by Terry and Ousley to the now commonly performed Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK) surgery. There are now considerable data in the literature to support the superiority of EK surgery results to the results following traditional full-thickness penetrating keratoplasty (PK). While the specific surgical techniques of DSAEK have become considerably easier and more varied, and the visual results of EK surgery have also improved, the complication rates have still remained largely a function of surgeon experience and specific technique variation. The current visual, refractive, and donor endothelial survival results of DSAEK are summarized in this chapter, and the complications of this procedure are reviewed.

Results

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