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

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.