MAY 24, 2023
A meta-analysis comparing ultrathin Descemet stripping automated endothelial keratoplasty (DSAEK) vs Descemet membrane endothelial keratoplasty (DMEK) suggests the two procedures are similarly successful across most outcome measures, but DMEK may afford better BCVA.
Ultrathin DSAEK is a newer surgical option for Fuchs endothelial dystrophy or bullous keratopathy that uses a thinner lamellar graft than traditional DSAEK. This systematic review and meta-analysis of comparison studies evaluated the efficacy and safety of ultrathin DSAEK vs DMEK. Seven studies were included: 3 randomized controlled trials (RCT), 2 retrospective fellow-eye studies, 1 retrospective comparative study involving 2 patient groups, and 1 prospective case series.
At all examined time points between 3 and 12 months postoperatively, DMEK was superior to ultrathin DSAEK in BCVA, although re-bubbling occurred at a higher rate in DMEK patients. Graft failure and rejection rates were not significantly different between the two groups.
The included studies had varying criteria for “ultrathin” DSAEK; the definition of "ultrathin" in this study was 130 µm versus the 100 µm that has been proposed in other studies.1 The relatively short 12-month follow-up time also limits the study’s ability to evaluate long-term complications, as certain complications (i.e., graft rejection) have a relatively low incidence rate within the first year but could ultimately influence the comparison of DMEK vs ultrathin DSAEK.
The choice between DMEK vs ultrathin DSAEK remains a debated topic in terms of which procedure may achieve the best visual acuity outcomes. This study suggests a BCVA benefit associated with choosing DMEK over ultrathin DSAEK, at least when comparing results up to 1 year postoperatively. Both techniques appear to be good treatment options for patients with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy, but longer follow-up studies involving more patients in an RCT are needed to further solidify the visual-outcome superiority of one technique over the other.
Financial Disclosures: Dr. Daniel Choi discloses financial relationships with Glaukos Corporation (Lecture Fees/Speakers Bureau); Kala Pharmaceuticals (Consultant/Advisor).
1 Cheung A et al. Cornea. 2018;37(5):661-666.