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DSAEK yields better visual results than other keratoplasty procedures
Smoothness of donor interface is the main reason for difference in visual acuity at 6 months, study says.
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Patients treated with Descemet’s stripping automated endothelial keratoplasty had significantly better best corrected visual acuity at 6 months postop compared with patients treated with Descemet’s stripping automated keratoplasty or deep lamellar endothelial keratoplasty, a study found.
Neda Shamie, MD, of Devers Eye Institute, and colleagues compared outcomes of 158 deep lamellar endothelial keratoplasty (DLEK) patients, 20 Descemet’s stripping endothelial keratoplasty (DSEK) patients and 63 Descemet’s stripping automated endothelial keratoplasty (DSAEK) patients. All of the surgeries were performed by a single surgeon using consistent techniques. Patient age, visual acuity and pachymetry were similar at baseline, the researchers said.
At 6-months postop, mean BCVA was 20/43 in the DLEK patients, 20/50 in the DSEK patients an 20/30 in the DSAEK patients. Mean visual acuity was similar between the DLEK and DSEK patients (P = .49) but was statistically better in the DSAEK group (P < .001).
At 6-months postop, 94% of the DSAEK patients had a BCVA of 20/40 or better vs. 59% of DLEK patients and 50% of DSEK patients. BCVA was 20/20 or better in 13% of the DSAEK patients and in only 1% and 6% of the DLEK and DSEK patients, respectively. In both cases, the DSAEK advantage was statistically significant (P < .001), the authors said.
The researchers also measured corneal topography and found no significant difference in mean astigmatism or keratometric values between the groups.
Why the difference?
Dr. Shamie observed two possible reasons for the difference in visual acuity with the DSAEK and DLEK procedures.
“First, there’s the automated microkeratome that’s used in preparing the donor. There is some evidence that says that using a microkeratome may result in more optically pure interface, or a smoother interface, vs. the manually cut,” Dr. Shamie told Ocular Surgery News. “And then the other difference is the stripped Descemet vs. the manually dissected recipient. Again, the interface would be purer.”
The difference between DSAEK and DSEK is largely because of smoothness of the donor interface engendered by use of a microkeratome in the DSAEK cases, she said.
Room for improvement
Dr. Shamie said endothelial keratoplasty, in all its forms, is a better option than penetrating keratoplasty for cases of endothelial dysfunction.
“We’ve proven that. But there are definitely steps in DSAEK that can still be improved,” she said.
As far as visual acuity is concerned, DSAEK is the best option currently available, but improvements could still be made to the smoothness of the donor interface, she said.
“Maybe the use of a femtosecond laser could improve the interface even more. Maybe down the line we’ll actually be able to transplant Descemet’s as the carrier for endothelial cells or maybe transplant cells or upregulate the multiplication of the endothelial cells of the recipient, and then we won’t even have an interface,” she said.
“I know the [study] was on vision, but let’s not lose focus on the true purpose of this procedure, which is to implant healthy, lasting endothelial cells for the patient,” she said. “There’s been a lot of hype about the procedure, which I think is justified, and we’re obtaining excellent visual results. But what’s happening now is that a lot of surgeons are losing sight of what’s at stake when you do obtain that.”
For more information:
- Neda Shamie, MD, can be reached at Devers Eye Institute, Good Samaritan Building 2, 1040 NW 22nd Ave., 2nd Floor, Portland, OR 97210; 503-413-8202; e-mail: nshamie@yahoo.com.
- Andy Moskowitz is an OSN Staff Writer who covers all aspects of ophthalmology.