Ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a fellow-eye comparison

Abstract

Background: To compare the visual outcome and patients' satisfaction after ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) performed on fellow eyes of the same patients. Methods: In this retrospective study, the records of 18 pseudophakic patients affected by Fuchs endothelial dystrophy who underwent DMEK in one eye and UT-DSAEK in the fellow eye were reviewed. Best corrected visual acuity (BCVA), corneal pachymetry, keratometry, corneal aberrations, photopic and mesopic contrast sensitivity, and endothelial cell counts measured 12 months after surgery in either eye were analyzed and compared. The results of a satisfaction questionnaire were also reviewed. Results: Twelve months after surgery, BCVA was not significantly different in UT-DSAEK and DMEK eyes (0.10 ± 0.04 and 0.07 ± 0.07 logMAR, respectively); at both 4-and 6 mm optical zones total and posterior corneal higher order aberrations (HOAs), posterior astigmatism and total coma were significantly lower after DMEK; BCVA in both groups was significantly correlated mainly with anterior corneal aberrations; contrast sensitivity was higher after DMEK especially in mesopic conditions and at medium spatial frequencies; the endothelial cell density was similar, although slightly higher in the UT-DSAEK group (p = 0.10). The satisfaction questionnaire showed that although patients were highly satisfied from both procedures, more than half of them preferred DMEK and reported a more comfortable and quicker postoperative recovery. Conclusions: DMEK and UT-DSAEK showed no evidence of difference in terms of postoperative BCVA, although DMEK had a better performance in terms of contrast sensitivity, posterior corneal aberrations and overall patient satisfaction.

Visual Quality and Subjective Satisfaction in Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) versus Descemet Membrane Endothelial Keratoplasty (DMEK): A Fellow-Eye Comparison

“…Mencucci et al [ 19 ] compared UT-DSAEK and DMEK in a similar study to ours, finding a difference of 0.023 logMAR favoring DMEK in BCVA. Moreover, clinical significant differences (2.5 letters or more) were considered unlikely among both procedures.…”

“…Additionally, they found that contrast sensitivity was higher after DMEK, especially in mesopic conditions and at medium spatial frequencies. Menucci et al [ 19 ] observed that the ECD was higher in the UT-DSAEK group; however, they did not observe statistically significant differences between both techniques. Regarding patient preference, they reported that although most patients were highly satisfied with their vision in both eyes, about one third reported better vision in the eye that underwent DMEK.…”

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

“…This allowed us to assume that the visual rehabilitation of patients after DMEK was shorter than that after UT-DSAEK. Indeed, data provided by Mencucci et al lead to a similar assumption that postoperative recovery after DMEK might be quicker than that after UT-DSAEK [ 7 ]. Our results are also in line with those from the randomized controlled DETECT trial, which documented that DMEK was associated with a postoperative shift in posterior corneal astigmatism but not UT-DSAEK [ 18 ].…”

“…There are only a few studies that compared DMEK and UT-DSAEK, and they mainly focused on visual acuity outcomes, contrast sensitivity, endothelial cell loss or complication rates [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Some studies also compared the patient-recorded outcome measures between both techniques [ 6 , 10 , 11 , 12 ].…”

“…In contrast, reports from other groups provided evidence that DMEK and UT-DSAEK did not differ significantly in terms of visual acuity [ 4 , 6 , 8 ]. Mencucci et al emphasized that DMEK and UT-DSAEK show no difference in postoperative best-corrected visual acuity (BCVA), although DMEK has a better performance in terms of contrast sensitivity and overall patient satisfaction [ 7 ].…”