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Long-term registry data comparing endothelial and full-thickness corneal transplantation provide useful context for surgical decision-making. In a Singapore Corneal Transplant Registry cohort, eyes undergoing DMEK, DSAEK, and penetrating keratoplasty (PK) for Fuchs endothelial corneal dystrophy or bullous keratopathy were followed for graft survival. DMEK showed the highest cumulative graft survival in the reported cohort, followed by DSAEK and PK. These results support the continued move toward lamellar endothelial replacement when disease is confined to the posterior cornea. However, retrospective registry comparisons can be influenced by patient selection, disease severity, surgeon preference, and changes in surgical practice over time. For clinicians, the key takeaway is that procedure choice should be anatomically driven. DMEK offers selective replacement of dysfunctional endothelium with a small graft, while DSAEK and PK remain valuable when anatomy, visualization, previous surgery, scarring, or other factors make DMEK less suitable. The study is a useful reminder that graft survival is only one outcome; visual rehabilitation, detachment rates, rebubbling, endothelial cell loss, rejection, and technical feasibility should all be integrated into the surgical plan.
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Long-term registry data comparing endothelial and full-thickness corneal transplantation provide useful context for surgical decision-making. In a Singapore Corneal Transplant Registry cohort, eyes undergoing DMEK, DSAEK, and penetrating keratoplasty (PK) for Fuchs endothelial corneal dystrophy or bullous keratopathy were followed for graft survival. DMEK showed the highest cumulative graft survival in the reported cohort, followed by DSAEK and PK. These results support the continued move toward lamellar endothelial replacement when disease is confined to the posterior cornea. However, retrospective registry comparisons can be influenced by patient selection, disease severity, surgeon preference, and changes in surgical practice over time. For clinicians, the key takeaway is that procedure choice should be anatomically driven. DMEK offers selective replacement of dysfunctional endothelium with a small graft, while DSAEK and PK remain valuable when anatomy, visualization, previous surgery, scarring, or other factors make DMEK less suitable. The study is a useful reminder that graft survival is only one outcome; visual rehabilitation, detachment rates, rebubbling, endothelial cell loss, rejection, and technical feasibility should all be integrated into the surgical plan.
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