Demography, Indications and Outcome of Descemet Stripping Automated Endothelial Keratoplasty in Nepal

Introduction: Descemet stripping automated endothelial keratoplasty (DSAEK) is performed for corneal endothelial pathology. It had gained popularity over penetrating keratoplasty (PK) because of better outcomes.Materials and methods: A retrospective data was collected from records of patients who underwent DSAEK from 2005 to 2019. Demography, indications and post-operative complications of DSAEK were analyzed. Outcome was measured in terms of graft clarity and vision.Results: Ninety-three eyes of 86 patients had undergone DSAEK in the study period of 15 years. Average age of the patients was 61.0 years. 55.9% were female. The common indications for DSAEK were cataract surgery related bullous keratopathy (n=47, 50.5%), Fuchs dystrophy (n=22, 23.6%) and failed graft (n=11, 11.8%). Eight cases (8.6%) had graft detachment and five (5.3%) had pupillary block in the early post-operative period. Outcome analysis was done for cases (n=80) which had follow-up duration of at least two months (range: 2 months to 11 years; average=28.5 months). Endothelial rejection occurred in eight cases (10.0%), five of which regained graft clarity after treatment. At the last follow-up visit, 23.8% (n=19) of grafts had failed, which was mostly due to endothelial failure (n=16); three grafts failed due to infective keratitis. Post-operatively, 42.5% (n=34) acquired best corrected vision of 6/18 or better with average astigmatic error of 1.6 diopter cylinder by refraction.Conclusion: DSAEK showed good outcome with our results comparable to other studies. It had replaced traditional penetrating keratoplasty in our institute for endothelial dysfunction. Surgeons in the country should be encouraged and trained to do the procedure.