Descemet Membrane Endothelial Keratoplasty versus Descemet Stripping Automated Keratoplasty – Outcome of One Single Surgeon’s More Than 200 Initial Consecutive Cases

Descemet Membrane Endothelial Keratoplasty versus Descemet Stripping Automated Keratoplasty – Outcome of One Single Surgeon’s More Than 200 Initial Consecutive Cases

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Christina Jansen,1 Madeleine Zetterberg1,2 1Department of Ophthalmology, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden; 2Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenCorrespondence: Christina JansenSahlgrenska University Hospital, Department of Ophthalmology, Mölndal, SE-431 80, SwedenTel +46 31 342 10 00Fax +46 31 41 29 04Email christina.jansen@vgregion.sePurpose: To compare clinical outcome and complications of Descemet stripping automated keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK).Methods: This is a retrospective study of the first consecutive cases of DSAEK and DMEK performed by a single surgeon at a tertiary referral centre.

Best-corrected visual acuity (BCVA), postoperative complications, rate of rebubbling and regraft were the main outcome measures.Results: The study included 241 eyes, 116 subjected to DSAEK and 125 to DMEK.Fuchs endothelial dystrophy (FED) was the predominant diagnosis in both groups.Mean BCVA at all follow-ups up to 2 years was in favour of DMEK.

Median BCVA (decimal) at 1 year was 0.4 (0.13– High Security 0.60; interquartile range) for the DSAEK and 0.

8 (0.6– 1.0) for the DMEK group, p< 0.001.

Preoperative BCVA in the DSAEK group was lower than in DMEK.There was no significant difference in visual improvement between groups at 1 year postoperatively.The most common postoperative complication in both groups was a pupillary block with high intraocular pressure, 27% and 34% respectively.This was not affected by the presence of an iridectomy/iridotomy.

In the DMEK group, gas provided significantly better adherence than air (p=0.020).Rebubbling for partial/total detachment was performed in 7% (DSAEK) and 11% (DMEK) of cases, p=0.361.

Regraft within 2 years was performed in 13% of eyes in the DSAEK and 17% in the DMEK group, p=0.450.No case of graft rejection occurred.Conclusion: Both DSAEK and DMEK provide overall satisfying outcome and the two techniques do not differ significantly in postoperative pupillary block, detachment rate, early graft failure or graft rejection.

However, differences 3 Piece Outdoor Dining Set at baseline may have influenced or obscured potential differences.In DMEK procedures, gas seems to facilitate early graft adherence.Keywords: corneal endothelial transplantation, Descemet membrane endothelial keratoplasty, Descemet stripping automated keratoplasty, regraft, rejection, visual outcome.