Meta-analysis of studies shows pros and cons of UT-DSAEK vs. DMEK
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A comprehensive search and comparison of studies on Descemet’s membrane endothelial keratoplasty and ultra-thin Descemet’s stripping automated endothelial keratoplasty highlighted the strengths and weaknesses of both procedures.
“Overall, 306 eyes were evaluated, of which 161 underwent UT-DSAEK and 145 underwent DMEK. Baseline visual acuity, endothelial cell density and central corneal thickness measures were similar between the cohorts. All eyes underwent a triple procedure that entailed endothelial keratoplasty, cataract removal and IOL insertion,” Daire Hurley, MD, said at the European Society of Cataract and Refractive Surgeons winter meeting.
In terms of visual acuity results, a statistically significant difference was observed in favor of DMEK at all time points up to 1 year of follow-up.
“Better visual outcomes and faster recovery are likely due to the improved restoration of anatomy in the DMEK procedure, as a result of the use of a thinner graft with no lamellae and a lack of a stroma-to-stroma graft interface. All patients analyzed across all studies were pseudophakic at the end of their keratoplasty, thus allowing comparable analysis of postoperative BCVA at 1 year,” Hurley said.
Ultra-thin DSAEK (UT-DSAEK), on the other hand, was found to have a more favorable safety profile with 23 complications as compared with 51 in the DMEK cohort. The most common was rebubbling, which occurred in 10 patients in the UT-DSAEK group vs. 30 in the DMEK group. Rates of graft failure and rejection were low, each occurring once in both cohorts.
“Previous studies have found DMEK to have less rejection compared to traditional DSAEK. As UT-DSAEK utilizes less donor tissue, this may result in rejection rates closer to those of DMEK,” Hurley said.
No difference in endothelial cell density was found between the two procedures, with an average loss of about one-third of cells from baseline.
Both procedures are viable options, and the choice may depend on surgical expertise, Hurley said.
“UT-DSAEK may be a better option for eyes with poor surgical view, complex anatomy and for less experienced surgeons, as it doesn’t have the same learning curve as DMEK,” he said.
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Hurley D. Ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus Descemet membrane endothelial keratoplasty (DMEK) – a systemic review & meta-analysis. Presented at: European Society of Cataract and Refractive Surgeons winter meeting; Feb. 18-20, 2022 (virtual meeting).
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