Three-year Outcomes of Endothelial Keratoplasty in Late-Stage Elderly Versus Younger Patients

Q: What was the primary purpose of the study?

To report 3-year clinical outcomes of corneal endothelial keratoplasty in late-stage elderly patients compared with younger patients.

Q: Which surgical procedures were included in the EK analysis?

Descemet’s stripping automated endothelial keratoplasty (DSAEK) and non-Descemet stripping and automated endothelial keratoplasty (nDSAEK) were included for bullous keratopathy.

Q: Did late-stage elderly patients experience higher complication rates?

No; intraoperative and postoperative complications were not different between late-stage elderly and younger groups.

Sep 28, 2026

Uploaded by anakgang17

This retrospective observational study reports 3-year clinical outcomes of corneal endothelial keratoplasty (EK) in late-stage elderly patients (≥75 years) compared with younger patients (<75 years). Patients undergoing DSAEK or nDSAEK for bullous keratopathy at Keio University Hospital between 2016 and 2018 were analyzed for graft survival, best-corrected visual acuity, endothelial cell density, and complications. Across 64 eyes, surgical-related outcomes were largely comparable, with better nDSAEK graft survival in the late elderly group and no increased safety risks.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

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Purpose

Study Design

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Clinical Interventions in Aging Open Access Full Text Article ORIGINAL RESEARCH Three-year Outcomes of Endothelial Keratoplastyin Late-Stage Elderly Versus Younger Patients Masatoshi Hirayama 1 , 2 , Risa Yamazaki-Hokama 1 , Takanori Suzuki 1 , Kazuno Negishi 1 1Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan; 2Department of Ophthalmology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan Correspondence: Masatoshi Hirayama, Department of Ophthalmology, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan, [Email mhirayama@fukuoka-u.ac.jp](Email mhirayama@fukuoka-u.ac.jp) | Purpose: This study aimed to report the 3-year clinical outcomes of corneal endothelial keratoplasty (EK) in late-stage elderly patients (≥75 years) compared with younger patients (<75 years) .
Study Design: Retrospective observational study.
Methods: Patients who underwent EK, including Descemet’s stripping automated keratoplasty (DSAEK) and non-Descemet stripping and automated endothelial keratoplasty (nDSAEK) with bullous keratopathy (BK) at Keio University Hospital between 2016 and 2018, were included. Patient characteristics, graft survival rate, best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), and complications were compared between the late elderly group (75 years or older) and the younger group (<75 years old) stratified by surgical procedure.
Results: Among the 64 eyes and 55 patients who underwent EK, 31 eyes and 30 patients were in the late elderly group (81.4±3.7 years), and 33 eyes and 25 patients were in the younger group (66.2±9.1 years) . There was no difference between the groups in terms of the cause ofBK, and PBK was more common in the DSAEK group in the late elderly group (p = 0.029) . There was no difference ingraft survival between the two groups during the follow-up period. In the late elderly group, graft survival was significantly better in the nDSAEK group than in the DSAEK group (p = 0.045) . BCVA and postoperative ECD improved in both groups. There were no differences in intraoperative or postoperative complications between the late elderly and younger groups.
Conclusion: EK for BK in late elderly patients resulted in postoperative visual improvement, with similar efficacy and safety to those of EK for BK in younger patients.
Keywords: bullous keratopathy, aging, Descemet’s stripping automated endothelial keratoplasty, non-descemet stripping and automated endothelial keratoplasty | | --- | | Introduction
Bullous keratopathy (BK) has been the leading indication for corneal transplantation in the United States and Canada over the past 34 years.1 For almost a century, penetrating keratoplasty (PK) was the standard surgical procedure for treating BK; however, in recent decades, endothelial keratoplasty (EK) has become the preferred approach because it allows faster visual recovery, requires smaller incisions, and reduces postoperative astigmatism and graft rejection.2 EK encompasses Descemet’s stripping automated EK (DSAEK), non-Descemet stripping EK (nDSAEK), and Descemet membrane EK (DMEK) . According to the Eye Bank Association of America, 89% of eyes with corneal endothelial dysfunction were treated with EK and only 11% with PK in 2019 (2019 Eye Banking Statistical Report Eye Bank Association of America, Washington, D.C (2020), p. 19) . DMEK has rapidly become the predominant procedure in Western countries, whereas in Japan, DSAEK and nDSAEK are still most commonly performed, with limited adoption of DMEK.3
When considering EK in elderly patients, ophthalmological characteristics such as a shallow anterior chamber ora history of glaucoma surgery,4,5 as well as systemic and functional aspects including cognitive and physical status,6 must be carefully evaluated,7 and surgical risk assessment in older patients is crucial for decision-making.8 Particularly in late- | Received: 5 June 2025 Accep

FAQs

What was the primary purpose of the study?

To report 3-year clinical outcomes of corneal endothelial keratoplasty in late-stage elderly patients compared with younger patients.

Which surgical procedures were included in the EK analysis?

Descemet’s stripping automated endothelial keratoplasty (DSAEK) and non-Descemet stripping and automated endothelial keratoplasty (nDSAEK) were included for bullous keratopathy.

Did late-stage elderly patients experience higher complication rates?

No; intraoperative and postoperative complications were not different between late-stage elderly and younger groups.

Sep 28, 2026

Uploaded by anakgang17