Endothelial keratoplasty: vision, endothelial survival, and complications in a comparative case series of fellows vs attending surgeons

Am J Ophthalmol. 2009 Jul;148(1):26-31.e2. doi: 10.1016/j.ajo.2009.01.022. Epub 2009 Apr 17.


Purpose: To compare a 6-month postoperative vision, endothelial cell loss, and immediate postoperative complications in Descemet stripping automated endothelial keratoplasty (DSAEK) cases performed by an experienced corneal surgeon and his inexperienced fellows using an established technique.

Design: Retrospective analysis of prospectively gathered data in 327 consecutive DSAEK cases.

Methods: DSAEK cases performed by fellows vs attending surgeons during a concurrent period were compared for 6-month postoperative best spectacle-corrected visual acuity (BSCVA), endothelial cell loss, and immediate postoperative complications. This series represents the initial consecutive cases performed by 3 cornea fellows using a technique identical to that used by the attending.

Results: After DSAEK, average BSCVA improved from 20/80 to 20/37 in the attending cases and 20/74 to 20/36 in the fellow cases. There was no statistical difference in endothelial cell loss between groups (32% vs 35%). The dislocation rate was 2% in the attending group and 1% in the fellow group. There were no primary graft failures or cases of pupillary block in either group.

Conclusions: This study demonstrates no difference in vision or endothelial cell loss after DSAEK when performed by an experienced corneal surgeon or inexperienced fellows. Postoperative complications also were similar. Results and complications of DSAEK performed by supervised novice fellows can equal those of an experienced DSAEK surgeon.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cell Count
  • Cell Transplantation
  • Clinical Competence*
  • Corneal Diseases / surgery
  • Corneal Transplantation / methods*
  • Descemet Membrane / surgery
  • Endothelium, Corneal / pathology
  • Endothelium, Corneal / transplantation*
  • Female
  • Graft Survival / physiology*
  • Humans
  • Male
  • Medical Staff, Hospital
  • Middle Aged
  • Ophthalmology
  • Postoperative Complications*
  • Retrospective Studies
  • Visual Acuity / physiology*