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  • Quality of Life After DMEK or Ultrathin DSAEK

    By Lynda Seminara
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, July 2019

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    In the primary Descemet Endothelial Thickness Comparison Trial (DETECT), postoperative visual acuity (VA) was better with Descemet membrane endo­thelial keratoplasty (DMEK) than with ultrathin Descemet stripping auto­mated endothelial keratoplasty (UT-DSAEK). In a preplanned secondary analysis of DETECT, Ang et al. looked at whether this benefit of DMEK trans­lates to enhanced vision-related quality of life (QoL). They found no meaning­ful differences between the study arms.

    The primary study included 38 patients with isolated endothelial dysfunction. Study eyes were assigned randomly to undergo UT-DSAEK or DMEK. The NEI’s 39-item Visual Function Questionnaire (NEI VFQ-39) was administered preoperatively and at three and 12 months postoperatively. In the secondary analysis, 38 eyes were involved in the three-month assessment and 26 eyes in the 12-month review. (For patients who had second-eye surgery between months 3 and 12, all subsequent NEI VFQ-39 data were excluded from analysis.) Responses were analyzed using the NEI-defined traditional subscales and composite score, on a 100-point scale and with Rasch-refined analysis.

    Mean VA at baseline was 0.35 logMAR (~20/50) in the DMEK arm and 0.28 logMAR (~20/40) in the UT-DSAEK arm. Each study arm included 19 patients: 18 with Fuchs dystrophy and one with pseudophakic bullous keratopathy. The mean age was 68 years for all participants.

    Overall, patients experienced improvement of 9.1 points in the NEI VFQ-39 composite score from baseline to month 3 (p < .001) and improve­ment of 11.6 points from baseline to month 12 (p < .001). At three months, improvement was 0.9 points greater for the DMEK group after controlling for baseline NEI VFQ-39 (p = .80 vs. UT-DSAEK group).

    In summary, even though VA in DETECT was better after DMEK than after UT-DSAEK, there was no signif­icant difference in patient-reported vision-related QoL between the study arms at month 3 or month 12. Although objective measurements such as VA are crucial for improving techniques of corneal transplantation, the authors believe that, regardless of their findings, patients are more concerned about vision-related QoL. (Also see related commentary by Alan Sugar, MD, in the same issue.)

    The original article can be found here.