Changing Practice Patterns and Long-term Outcomes of Endothelial Versus Penetrating Keratoplasty: A Prospective Dutch Registry Study
Dickman MM, Peeters JM, van den Biggelaar FJ, et al Am J Ophthalmol. 2016;170:133-142
Study Summary
The authors looked at the changing practice patterns in corneal transplantation and compared the long-term outcomes of Descemet stripping endothelial keratoplasty (EK) with penetrating keratoplasty (PK).
They reviewed the graft survival, visual acuity, refractive error, and endothelial cell density (ECD) for the treatment of Fuchs endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK) based on prospectively collected data from The Netherlands Organ Transplantation Registry. The registry includes all consecutive primary Descemet stripping EKs and PKs performed in The Netherlands for the treatment of FED or PBK between January 1, 1998, and December 31, 2013.
This study included 2725 EKs and 2390 PKs. The overall lost-to-follow-up rate was 19% for EK and 31% for PK; but, since EK became widely performed in The Netherlands in 2007, the lost-to-follow-up rate has been 19% for EK and 16% for PK. The 5-year follow-up data were the longest evaluated in this study.
The 2-year graft survival was statistically significantly higher for PK than EK for both FED (97.4% vs 95.2%) and PBK (94.5% vs 88.7%). Approximately one third of the EK grafts failed due to primary graft failure, whereas only 2%-3% of PK grafts failed due to primary graft failure. Graft survival from year 2 to year 5 was statistically significantly higher in the EK eyes than the PK eyes (98.2% vs 95.2% for FED and 97.2% vs 85.9% for PBK). At 5 years, no difference in graft survival was found between the two groups (FED: 94% for EK and 93.3% for PK; PBK: 87.3% for EK and 84.1% for PK). Not surprisingly, the researchers found greatly improved 2-year graft survival rates for the EKs performed more recently, indicating a significant learning curve for this procedure. Survival rates remained stable for PK over the study period. In fact, for EKs performed between 2012 and 2014, the 2-year graft survivals were almost identical to those for PKs.
