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

Abstract

AimsThis study aims to compare the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) in patients with corneal endothelial dysfunction due to Fuchs’ endothelial dystrophy or pseudophakic bullous keratopathy.MethodsWe conducted a meta-analysis using a literature search of Embase, PubMed, Cochrane CENTRAL, ClinicalTrials.gov and WHO ICTRP databases. We included randomised controlled trials (RCTs) and cohort studies that compared DMEK and UT-DSAEK (graft<130 µm), with a follow-up of ≥12 months, published until 20 February 2022. We used the Revised Cochrane risk-of-bias tool for RCTs and the Risk of Bias in Non-Randomised Studies-of Interventions system for cohort studies.ResultsOut of 144 records, 8 studies (3 RCTs, 2 fellow-eye studies and 3 cohort studies) were included, encompassing 376 eyes, (N=187 DMEK vs N=189 UT-DSAEK). The 12-month logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA) was better post-DMEK (mean difference −0.06 (95% CI −0.10 to –0.02)), but with higher rebubbling risk: OR 2.76 (95% CI 1.46 to 5.22). Heterogeneity was significant I2=57%. Findings were consistent when excluding retrospective studies, including only studies with low risk of bias or RCTs only. An analysis of studies with mean DSAEK grafts <70 µm showed no significant difference in BCVA between the procedures. Publication bias was found in the BCVA analysis (Egger’s test p=0.023).ConclusionsPost-DMEK BCVA is superior to post-UT-DSAEK when using <130 µm grafts. DSAEK grafts <70 µm may not significantly differ from DMEK. The higher risk of rebubbling with DMEK necessitates an appropriate selection of patients.PROSPERO registration numberCRD42022340805.

Scheimpflug Corneal Densitometry Patterns at the Graft–Host Interface in DMEK and DSAEK: A 12-Month Longitudinal Comparative Study

“…In the postoperative period, corneal densitometry readings may be influenced by a range of inflammatory and fibrotic factors, including edema, corneal stromal fiber hyperplasia, and inflammation. These parameters, integral to the cornea's healing and recovery processes, can affect transparency and are essential considerations when evaluating the outcomes of DMEK and DSAEK surgeries [14]. The interpretation of densitometry must, therefore, be contextualized within the framework of the cornea's response to surgical intervention and its subsequent repair mechanisms.…”

“…Corneal densitometry, serving as an objective metric, quantitatively gauges the transparency of the cornea, which is indicative of its optical quality [14]. This parameter measures the amount of backscattered light from the cornea, utilizing a standardized scale to provide a precise assessment of corneal clarity.…”