Ten-year outcomes of Descemet stripping endothelial keratoplasty versus penetrating keratoplasty in Hong Kong: a retrospective cohort study

Background This study compares the long-term survival of primary endothelial versus penetrating keratoplasty in Hong Kong patients with Fuchs endothelial dystrophy (FED) or pseudophakic bullous keratopathy (PBK). Methods A ten-year retrospective cohort of patients who received primary Descemet stripping endothelial keratoplasty (DSEK) or penetrating keratoplasty (PKP) for either FED or PBK at an academic ophthalmology department in Hong Kong between 2006 and 2015 was conducted. Results Seventy-four eyes of 65 patients received primary keratoplasties with a mean follow-up of 95 months, comprising 41 DSEK and 33 PKP. Overall graft survival rates were 76.1% at 5 years and 55.0% at 10 years. DSEK demonstrated higher survival rates than PKP, with 82.1% versus 68.8% survival at 5 years ( P  = 0.31) and 63.8% versus 43.5% at 10 years ( P  = 0.15). Older age was a predictive factor for graft failure. Postoperative best-corrected visual acuity (BCVA) was significantly better for DSEK at 5 years ( P  = 0.006). Graft ulcers occurred in fewer eyes receiving DSEK (4.9%) compared to PKP (21.2%) at 10 years ( P  = 0.033). The cumulative rejection rates were 12.2% for DSEK and 9.1% for PKP at 10 years ( P  = 0.67) while 14.6% of DSEK and 12.1% of PKP required a re-graft ( P  = 0.75). Conclusions Both primary DSEK and PKP yielded satisfactory survival outcomes among Hong Kong patients with FED or PBK. Older age predicted a worse graft survival. Patients undergoing DSEK experienced superior BCVA at 5 years and a lower risk of graft ulcers at 10 years. DSEK and PKP had similar rejection and re-graft rates under close monitoring and timely management.