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DSAEK eyes have thicker corneas, steeper posterior curvature than DMEK eyes
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Thicker corneas and steeper posterior corneal curvature were seen in eyes that underwent Descemet’s stripping automated endothelial keratoplasty compared with eyes that underwent Descemet’s membrane endothelial keratoplasty, according to a study.
The retrospective study included 20 eyes of 10 patients with Fuchs’ endothelial dystrophy who underwent DSAEK in one eye and DMEK in the contralateral eye.
Four DMEK eyes and three DSAEK eyes had cataracts that were removed concurrently with corneal transplantation. Four DMEK eyes and four DSAEK eyes were pseudophakic and had posterior chamber IOLs. Two DMEK eyes and three DSAEK eyes were phakic with no cataracts.
Postoperatively, posterior curvature was significantly greater in DSAEK eyes than in DMEK eyes.
Corneal thickness was 627.9 µm in DSAEK eyes and 541 µm in DMEK eyes. The difference was statistically significant (P = .007).
“This difference may explain the hyperopic shift commonly observed after DSAEK and should be considered when choosing an intraocular lens for cataract surgery,” the study authors said.
Front flat keratometry and front steep keratometry readings were similar in DMEK and DSAEK eyes. Between-eye differences in anterior and posterior astigmatism and Q values were also insignificant.
Disclosure: The authors have no relevant financial disclosures.
Perspective
Back to TopMarianne O. Price, PhD
This fellow-eye study design nicely confirms findings from previous cohort studies showing that compared with DMEK, DSAEK results in a thicker central corneal pachymetry and increased posterior corneal curvature. The fundamental difference between DMEK and DSAEK is that DSAEK includes some donor stromal tissue while DMEK does not. A DSAEK graft is prepared by microkeratome dissection, and the lenticule that is produced frequently is thicker in the periphery because the microkeratome references off the anterior corneal surface while the donor corneal thickness varies from center to periphery. Other studies have shown that variations in the donor stromal thickness result, on average, in a greater hyperopic shift and increased higher-order aberrations after DSAEK than after DMEK; this study did not evaluate refractive or wavefront outcomes.
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