Clinical outcomes of Descemet’s stripping endothelial keratoplasty using a manual or automated procedure at Undaan Eye Hospital Surabaya, Indonesia: with one-year follow up

Abstract

Background: Endothelial keratoplasty (EK) is a selective lamellar corneal transplantation technique that replaces damaged endothelium while preserving the patient's corneal stroma. Donor graft preparation can be done using Descemet stripping endothelial keratoplasty (DSEK) or Descemet stripping automated endothelial keratoplasty (DSAEK). Research on EK in Indonesia is currently underreported, but it is crucial for developing strategies to treat corneal blindness in the future. This study aimed to present visual acuity, graft survival, and complications after DSEK or DSAEK at Undaan Eye Hospital Surabaya. Methods: This study involved 17 eyes, treated with DSEK or DSAEK surgery between 2017 and 2022. Patients with other ocular diseases and incomplete medical records were excluded. Best corrected visual acuity (BCVA) was documented before the surgery, and at 1 day, 1, 3, 6 months, and 1 year after. Data in this study were analyzed using multiple techniques, including Wilcoxon, Kaplan-Meier survival, and bivariate logistic regression analysis. Results: The postoperative mean BCVA significantly increased to 1.36 ± 0.57 logMAR (p=0.012) at 1 day, 1.02 ± 0.62 logMAR (p=0.002) at 1 month, 0.94 ± 0.66 logMAR (p=0.002) at 3 months, 0.72 ± 0.66 logMAR at 6 months (p=0.000), and 0.74 ± 0.74 logMAR (p=0.001) at 1-year compared to preoperative BCVA of 1.84 ± 0.39 logMAR. The graft could survive 100% within 1 day to 6 months and 76% within 1 year after surgery. Bivariate logistic regression showed donor origin had a statistically significant effect with p-value = 0.031 and odds ratio = 1.8, 95% confidence interval (CI) = 1.003 - 3.229. Corneal edema was the most common complication in the early and late postoperative periods. Conclusion: DSEK or DSAEK surgery is safe, effective, and viable. It shows good visual outcomes and becomes the most used EK treatment for corneal endothelial dysfunction.