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

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 of BK, and PBK was more common in the DSAEK group in the late elderly group (p = 0.029). There was no difference in graft 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.