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  • DMEK Versus Ultrathin DSAEK for Corneal Endothelial Dysfunction

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, January 2019

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    Results of nonrandomized and obser­vational studies have suggested that visual outcomes are similar for Descem­et membrane endothelial keratoplasty (DMEK) and ultrathin Descemet strip­ping automated endothelial keratoplasty (UT-DSAEK). However, the study designs have hindered direct com­parisons. To permit a more meaningful comparison of these procedures, Cham­berlain et al. conducted a randomized controlled trial to evaluate visual outcomes and complication rates. They found that DMEK yielded superior visual acuity during the year following surgery, although complication rates were similar for the two procedures.

    Comparison

    COMPARISON. Clinical photographs and OCT images from patients who underwent UT-DSAEK (left) and DMEK (right).

    Eligible participants had damaged or diseased endothelium (from Fuchs endothelial dystrophy or pseudophakic bullous keratopathy). Within two days prior to surgery, eyes were assigned randomly to receive DMEK or UT-DSAEK. Standardized surgical tech­niques were used. Patients were masked as to their intervention and received the same postoperative instructions. Moreover, the refractionist who assessed visual outcomes was unaware of each patient’s procedure. The primary out-come was best spectacle-corrected visual acuity (BSCVA) at six months. Secondary outcomes were BSCVA at the three- and 12-month marks, intra- and postoperative complications, endothelial cell counts, and change in pa­chymetry.

    Of the 216 patients with endothelial dysfunction who were screened, 38 (50 eyes) were enrolled. After the research­ers corrected for baseline VA, DMEK was found to result in better visual out­comes. BSCVA was 1.5 lines better for the DMEK group at three months, 1.8 lines better at six months, and 1.4 lines better at 12 months. At six months, the average endothelial cell count was 1,963/mm2 in the DMEK group and 2,113/mm2 in the UT-DSAEK group. At 12 months, the average cell counts were 1,855/mm2 and 2,070/mm2, respectively.

    Rates of intra- and postoperative complications were comparable for the study groups.

    The authors noted that DMEK—when performed by experienced surgeons—appears to elicit better visual outcomes and faster recovery than UT-DSAEK. They emphasized that larger multicenter trials may help to clarify the dissimilar outcomes. (Also see related commentary by Marianne Price, PhD, in the same issue.)

    The original article can be found here.