Comparative Analysis of Corneal Parameters in Swept-Source Imaging between DMEK and UT-DSAEK Eyes

Abstract

Background: The need to provide a comparative analysis of corneal parameter changes compared to their preoperative values between Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) patients. Methods: The study included 24 eyes after UT-DSAEK and 24 eyes after DMEK. Visual acuity, endothelial cell count (ECC), central corneal thickness (CCT), mean keratometry (MK), mean astigmatism (MA), astigmatism asymmetry (AA) and higher-order aberrations (HOAs) were assessed at baseline and 1, 3, 6 and 12 months after the surgery. Results: From the 3rd month post operation, ECC was higher in the DMEK eyes than in the UT-DSAEK eyes (p = 0.01). In a bivariate analysis that was adjusted for age, DMEK was associated with a smaller decrease in posterior MK at the 1-month (β = −0.49, p = 0.002), 3-month (β = −0.50, p < 0.001), 6-month (β = −0.58, p < 0.001) and 12-month (β = −0.49, p < 0.001) follow-up visits. There were no significant differences in changes in anterior or combined surface MK throughout the observation period. Accordingly, no significant differences in changes in MA, AA or HOAs compared to the baseline values were identified between the eyes after DMEK and UT-DSAEK at any follow-up time point. Conclusions: UT-DSAEK seemed to be an easier and safer technique than DMEK while maintaining similar outcomes regarding irregular astigmatism and total keratometry values.

Descemet membrane endothelial keratoplasty compared with ultrathin Descemet stripping automated endothelial keratoplasty: a meta-analysis

“…The risk of bias was low in two RCTs,19 21 and in one RCT, there were some concerns regarding the patients selection and the reported result,20 which differed from former publications from this trial43 46 (figure 2A). The risk of bias was serious in one cohort study,22 and critical in four cohort study,23–25 39 mainly due to confounding. Other issues included the lack of assessors blinding and concerns regarding the reported result (figure 2B).…”

“…The systematic literature search yielded 144 records (online supplemental file 2), of those 8 studies met the inclusion criteria (figure 1), totalling 376 eyes, 189 and 187 in the UT-DSAEK and DMEK groups, respectively. This included three RCTs,19–21 two fellow-eye studies22 23 and three cohort studies 24 25 39. In both fellow-eye studies, UT-DSAEK was performed before DMEK.…”

“…The 12-month logMAR BCVA was not available in two studies 23 39. Combining data from 6 studies (308 eyes), using the random-effect model, DMEK showed a significantly better BCVA than UT-DSAEK 12-month postsurgery, with a mean difference −0.06 (95% CI −0.10 to –0.02) (figure 3A).…”

“…Data regarding graft rejection 12-month post-transplantation were available for 300 eyes (6 studies) 19–22 24 39. Graft rejection was reported in one eye in the UT-DSAEK group 21.…”

Ultrathin-Descemet Stripping Automated Endothelial KeratoplastyVersusDescemet Membrane Endothelial Keratoplasty: A Systematic Review and Meta-analysis

“…Thirty-three of the 39 remaining articles did not present usable data. Finally, six studies were eligible based on the inclusion criteria and selected for this meta-analysis (16)(17)(18)(19)(20)(21). Figure 1 demonstrates the Preferred Reporting Items for systematic review and meta-analyses (PRISMA) study flow diagram.…”