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AAO reports superior results of DMEK vs. DSEK
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A report of the America Academy of Ophthalmology, based on extensive review of the literature, provided evidence that DMEK is a safe and effective procedure, superior to DSEK for visual recovery times, visual outcomes and rejection rate.
A total of 1,085 articles in English language were reviewed, of which 47 were relevant to assess the safety and efficacy of Descemet’s membrane endothelial keratoplasty (DMEK) vs. Descemet’s stripping endothelial keratoplasty (DSEK). The follow-up ranged between 5.3 and 68 months.
A better visual recovery was shown after DMEK than DSEK. When visual acuity outcomes were compared, best corrected visual acuity of 20/25 or better and 20/20 or better were achieved in a significantly higher percentage of DMEK than DSEK patients. Only 6% of the eyes after DSEK achieved 20/25, whereas 50% of DMEK eyes achieved that level in one study.
The most common complication of DMEK was partial graft detachment, which was resolved with one application of air injection in most cases. Total graft detachment occurred in less than 5% of cases. Primary DMEK graft failure rate was 1.9% compared with 5% after DSEK. A lower immune rejection rate was reported after DMEK, likely due to the lesser amount of tissue transplanted.
IOP elevation rates were comparable between the two techniques, despite the larger bubble required in DMEK surgery. Endothelial cell loss was greater in the early period after DMEK and decreased after 3 months.
“This initial loss likely was the result of iatrogenic damage from graft manipulation,” the authors said.
Taking into account that DMEK is a more technically challenging technique, “the complication rate will continue to decrease as the DMEK techniques mature and surgeon experience increases,” they said – by Michela Cimberle
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Marianne O. Price, PhD
According to this study, DMEK currently provides more rapid and reliable visual recovery for patients with corneal endothelial dysfunction than standard DSEK/DSAEK or PK. Technique refinements have reduced the DMEK learning curve and this is encouraging the adoption of DMEK by surgeons worldwide.
However, the jury is still out. Rudy Nuijts, MD, PhD, and colleagues conducted a randomized clinical trial in which ultra-thin DSAEK provided better visual outcomes than standard DSAEK. He has now organized a randomized clinical trial comparing DMEK with ultra-thin DSAEK. It will be very interesting to see what that study finds.
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