Work

Thirty-six-month outcomes of femtosecond laser-assisted DSEK and PKP for corneal endothelial decompensation

Year: 2026

Type: article

Abstract: Purpose To compare the 36-month postoperative outcomes between femtosecond laser–assisted Descemet stripping endothelial keratoplasty (FS-DSEK) and femtosecond laser–assisted penetrating keratoplasty (FS-PKP) for corneal endothelial decompensation under indication-based surgical selection. Methods This single-center retrospective study enrolled 130 eyes of 130 patients. A total of 68 eyes underwent FS-DSEK, and 62 eyes underwent FS-PKP. Procedure selection was based on pathological depth and the severity of corneal structural involvement. Visual acuity, minimal corneal thickness, ocular discomfort symptoms, refractive parameters, endothelial biomarkers, graft survival rate, and postoperative complications were evaluated throughout the 36-month follow-up. Longitudinal clinical outcomes were analyzed using generalized estimating equations (GEE), while graft survival was estimated via by Kaplan–Meier analysis. Results Baseline demographics, preoperative ocular characteristics, donor-related factors, and surgical indication were comparable between the two groups. The median time to corneal transparency was significantly shorter in the FS-DSEK group [4.0 (3.0, 5.25) vs 5.0 (4.0, 7.0) days, P = 0.008]. Both groups showed significant improvements in ocular discomfort and thinnest corneal thickness during follow-up. Visual recovery patterns differed significantly between the two groups: FS-DSEK yielded faster improvement in uncorrected and best-corrected visual acuity during the early-to-intermediate postoperative period, while long-term visual outcomes eventually converged. Spherical equivalent remained stable in both groups, whereas astigmatism level was consistently lower in the FS-DSEK group. Endothelial cell density decreased in both groups; the FS-DSEK group demonstrated greater early-to-intermediate endothelial cell loss, which gradually attenuated over subsequent follow-up. The 36-month graft survival rate was 86.7% and 75.8% in the FS-DSEK and FS-PKP groups, respectively, without statistically significant difference (P = 0.198). Graft dislocation occurred exclusively in the FS-DSEK group. Conclusion Under indication-based surgical allocation FS-DSEK provides faster corneal clarification and earlier visual recovery with lower astigmatism, whereas FS-PKP remains essential for eyes with irreversible stromal lesions or full-thickness pathological changes.

Source: BMC Ophthalmology

DOI: 10.1186/s12886-026-05241-6