Center and Surgeon Effect on Outcomes of Endothelial Keratoplasty versus Penetrating Keratoplasty in the United Kingdom

Transplant Rejection Following Endothelial Keratoplasty and Penetrating Keratoplasty in the United Kingdom: Incidence and Survival

“…This suggests that based on a median follow-up period of 18.7 months (mean 24.5, range 12-84, SD 19.9), the median rejection rate for EK is 6.0% (mean 6.4%, range 0-14, SD 4.1). Graft survival following EK has been recently reported to be significantly lower than PK in the United Kingdom (23) , in a report investigating any correlation between graft survival and refractive outcomes with surgeon/centre experience, without investigating the effect of rejection on graft survival. The Australian Corneal Graft Registry also reported similar results (24) .…”

Corneal Transplant Surgery for Keratoconus and the Effect of Surgeon Experience on Deep Anterior Lamellar Keratoplasty Outcomes

“…13,21 Only when analyzing the complete refractive error do the high variability and unpredictability of the postoperative refractive error become apparent following either DALK or PKP. 22 Importantly, the refractive error was not dependent on surgeon experience (within the defined groups) or on the donorto-host trephine size difference. Patients with keratoconus tend to be younger, perhaps with high expectations, and may be dissatisfied with such high refractive errors.…”

“…Interestingly, the finding of a surgical learning curve for endothelial keratoplasty, which would be regarded by most experienced surgeons as a less complex procedure than DALK, adds further weight to the suggestion that lamellar procedures may have less predictable outcomes overall. 20,22 The plateau in the uptake of DALK (at least in the United Kingdom) suggests that further work is needed to make DALK more predictable and easier to perform so that its outcome, including the refractive outcome, is consistently superior to PKP. …”

Evaluation of Endothelial Pump Function in Fuchs Endothelial Dystrophy Before and After Endothelial Keratoplasty

“…5 DSAEK has become the most widely performed type of keratoplasty for endothelial disorders, of which Fuchs endothelial corneal dystrophy (FECD) is by far the most common among whites. 6,7 In recent years, DSAEK has been further developed into Descemet membrane endothelial keratoplasty, 8,9 which has not yet been as widely adopted as DSAEK. 10 As a consequence of these improvements, more patients than ever are receiving corneal transplantation.…”

“…10 As a consequence of these improvements, more patients than ever are receiving corneal transplantation. 6,7 Unfortunately, as EK procedures are relatively new, studies on long-term graft survival are scarce, which makes endothelial cell (EC) density the available marker of the potential for graft longevity along with graft failure. However, using EC densities as an indicator of graft longevity after DSAEK is not uncomplicated.…”