Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) produce similar results in terms of mean best spectacle-corrected visual acuity (BSCVA), according to study results published in Ophthalmology, but a higher percentage of DMEK eyes reached 20/25 or better Snellen acuity. However, significantly more adverse events occurred after DMEK, according to the study.

Data comparing DMEK with UT-DSAEK for the treatment of corneal endothelial dysfunction are scarce. This study compared BSCVA, endothelial cell density (ECD), refractive astigmatism, and complications of DMEK vs UT-DSAEK in pseudophakic eyes with Fuchs’ endothelial corneal dystrophy.

In this prospective, multicenter randomized controlled trial, researchers evaluated 54 pseudophakic adults with corneal endothelial dysfunction caused by Fuchs’ endothelial corneal dystrophy. Patients were randomly assigned to receive DMEK (n=29) or UT-DSAEK (n=25) based on preoperative BSCVA, recipient central corneal thickness, gender, age, and recruitment center. All patients had corneas prestripped and precut for their respective procedures. The primary outcome measure was high-contrast BSCVA, and secondary outcome measures were ECD, refractive astigmatism, and complications.


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Researchers revealed that BSCVA improved after both DMEK and UT-DSAEK to a similar extent, and that postoperative BSCVA did not differ significantly between DMEK and UT-DSAEK at 3 months (0.15 logarithm of the minimum angle of resolution [logMAR] [95% CI, 0.08-0.22 logMAR] vs 0.22 logMAR [95% CI, 0.16-0.27 logMAR]; P =.15), 6 months (0.11 logMAR [95% CI, 0.05-0.17 logMAR] vs 0.16 logMAR [95% CI, 0.12-0.21 logMAR]; P =.2), and 12 months (0.08 logMAR [95% CI, 0.03-0.14 logMAR] vs 0.15 logMAR [95% CI, 0.10-0.19 logMAR]; P =.06). The percentage of eyes reaching 20/25 or better Snellen BSCVA was higher in DMEK patients compared with UT-DSAEK patients (66% vs 33%; P =.02). ECD did not differ significantly between DMEK patients and UT-DSAEK patients at postoperative follow-up visits. The total number of complications at the 1-year follow-up was higher after DMEK compared with UT-DSAEK (17/29 vs 6/24; P =.01).

Limitations to this study were that the assessors of BSCVA were not masked, and corneal surgeons practiced their own surgical techniques, which may have influenced complication rates.

The study researchers concluded that DMEK and UT-DSAEK produce similar mean BSCVA and that the percentage of eyes reaching 20/25 Snellen vision is significantly higher with DMEK than with UT-DSAEK.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Dunker SL, Dickman MM, Wisse RPL, et al. Descemet membrane endothelial keratoplasty versus ultrathin Descemet stripping automated endothelial keratoplasty: a multicenter randomized controlled clinical trialOphthalmol. 2020;127(9):1152-1159. doi: 10.1016/j.ophtha.2020.02.029