Corneal Procedures Demonstrate Comparable Long-Term Visual Outcomes, Patient Satisfaction

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DMEK and DSAEK resulted in similar best spectacle-corrected visual acuity.

Long-term follow-up comparing Descemet’s membrane endothelial keratoplasty (DMEK) and Descemet’s stripping automated endothelial keratoplasty (DSAEK) in fellow eyes found comparable levels of best spectacle-corrected visual acuity (BSCVA) and patient satisfaction, according to research results published in the American Journal of Ophthalmology. Although DMEK eyes reached BSCVA sooner, DSAEK eyes improved over a longer period of time. 

Researchers conducted a 2-centered, retrospective case series study of patients in order to determine the long-term outcomes of DSAEK vs DMEK. Investigators’ previous clinical experiences have demonstrated that eyes that underwent DSAEK “continued to show improvement” for several postoperative years. 

The study cohort included 128 eyes from 64 patients (40 women; aged 70.18±9.61 years) who underwent DSAEK for Fuchs endothelial dystrophy followed by DMEK in the fellow eye between 2010 and 2018. Twenty-nine patients underwent DMEK alone; 35 underwent DMEK plus phacoemulsification and posterior chamber intraocular lens implantation. Thirty-three patients underwent DSAEK alone and 31 underwent DSAEK plus phacoemulsification and posterior chamber intraocular lens implantation. 

In the DMEK group, preoperative best spectacle-corrected visual acuity (BSCVA) was 0.36±0.26 logMAR (Snellen acuity 20/46); in the DSAEK group, BSCVA was 0.42±0.34 (Snellen acuity, 20/52). Average follow-up time in each group was 1311 and 2456 days or 3.6 and 6.7 years, respectively. Time to achieve BSCVA in each group was 277±308 days and 490±501 days in the DMEK and DSAEK groups, respectively. 

In long-term follow-up, postoperative BSCVA was not statistically significantly different between groups. In the DMEK group, 73% of eyes achieved 0.10 logMAR (Snellen acuity 20/25) or better, vs 64% in the DSAEK group. Fifty-one percent and 41% in each group, respectively, achieve 0.00 logMAR (Snellen acuity 20/20). Average spherical equivalent in the DMEK group was -0.08 vs 0.06 in the DSAEK group.

Twenty-two patients preferred the DMEK eye, 17 preferred the DSAEK eye, and 25 reported no difference. 

In the DSAEK group, the average preoperative thickness of the donor lenticule was 137 µm and 139 µm in each clinic. A subset of patients underwent postoperative optical coherence tomography, and investigators found that the average tissue thickness decreased by 12 µm during the postoperative period. 

Study limitations include those inherent to retrospective research, as well as a lack of randomization to each procedure type, biases in patients who undergo bilateral ocular surgery in terms of eye preference, and a lack of optical coherence tomography in all patients or standardized survey to evaluate patients in a postoperative setting.

“[T]o our knowledge, this is the largest fellow eye study with the longest follow-up time comparing DMEK vs DSAEK for the treatment of Fuchs endothelial dystrophy,” according to the researchers. “We found that DMEK eyes had more rapid visual rehabilitation, taking on average 277 days to reach BSCVA, while the DSAEK eyes took 490 days.”

“At 5 years, our data show DMEK and DSAEK have comparable levels of BSCVA and patient satisfaction,” the report shows. 


Weisenthal RW, Yin HY, Jarstad AR, Wang D, Verdier DD. Long term outcomes in fellow eyes comparing DSAEK and DMEK for treatment of Fuchs corneal dystrophy. Am J Ophthalmol. Published online June 19, 2021. doi:10.1016/j.ajo.2021.06.013