Triple Procedure Long-Term Outcomes: Comparative Analysis of Penetrating Keratoplasty vs. DSAEK Combined with Cataract Surgery

<b>Background/Objectives</b>: This study assessed outcomes between penetrating keratoplasty (PK) and Descemet's stripping automated endothelial keratoplasty (DSAEK) when combined with cataract surgery as part of the triple procedure. <b>Methods</b>: Retrospective analysis of 727 triple procedures (525 PK and 202 DSAEK) from 2007-2023. Graft survival, visual acuity, and refractive outcomes were analyzed. Kaplan-Meier and Cox regression were used for survival and prognostic analysis. <b>Results</b>: No statistically significant difference in survival was found (PK-42 months; DSAEK-47 months). DSAEK had better visual acuity improvement and refractive stability. PK had higher astigmatism and variability in refractive error. <b>Conclusions</b>: While graft survival was comparable, DSAEK offers superior visual rehabilitation, supporting its use when refractive predictability is important.