Endothelial cell loss after Descemet's stripping endothelial keratoplasty in a large prospective series

Purpose: To report the donor endothelial cell loss in the first year after Descemet's stripping endothelial keratoplasty (DSEK) for the treatment of endothelial dysfunction. Design: Prospective noncomparative interventional case series. Participants: Eighty eyes of 78 patients with corneal edema. Methods: Eighty eyes with endothelial failure were entered into a prospective study of endothelial keratoplasty (EK). The donor central endothelial cell density (ECD) was recorded postoperatively at 6 months (n = 80) and 12 months (n = 80) and then compared with the preoperative eye bank measurements. The subsets of eyes with the donor prepared manually (DSEK; n = 19) and the donor prepared with a microkeratome (Descemet's stripping automated EK [DSAEK]; n = 61) were also evaluated and compared. Main Outcome Measures: Preoperative and postoperative central ECDs were prospectively evaluated and the cell loss calculated for each postoperative time point. Results: The average and standard deviation ECD at 6 months was 1908 +/- 354 cells/mm(2), representing a mean cell loss from preoperative donor cell measurements of 34 +/- 12%. At 12 months, ECD was 1856 +/- 371 cellS/mm(2) (35 +/- 13% cell loss). The 1% additional cell loss from 6 to 12 months was not significant (P = 0.233). In the subset of DSEK eyes (n = 19), the cell loss from preoperatively to 6 months was 34%, and at 12 months it was 39%. In the subset of DSAEK eyes (n = 61), the cell loss from preoperatively to 6 months was 34%, and at 12 months it was 34%. There was no statistical difference between the cell loss from DSEK and that from DSAEK at 6 months (P = 0.884) or at 12 months (P = 0.224). Conclusions: Descemet's stripping EK using our surgical technique has a mean donor endothelial cell loss of 34% at the 6-month postoperative examination, and this average cell loss remains relatively stable up to at least 1 year. We found no difference in cell loss between the DSEK and DSAEK techniques over this 1-year postoperative period.