Corneal endothelial keratoplasty: DMEK vs UT-DSAEK

There were no differences between the two techniques in terms of best corrected visual acuity, refractive astigmatism, and endothelial cell loss. However, more patients who had undergone DMEK had 20/25 Snellen vision.

Cornea Slitlamp

On slit-lamp examination, the five layers of the cornea can be visualized. The endothelium, however, is best seen using specular reflection.

The endothelial layer is important in keeping the cornea clear and maintaining visual acuity. The number of cells in the endothelial layer is fixed at birth and decreases as a person ages. In some diseases and after some ophthalmic surgeries, the endothelium becomes damaged and may need to be replaced in a process called keratoplasty.

Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) are two of the methods that are commonly used to replace the endothelial layer. In DMEK, only a thin layer of endothelium is inserted as a replacement. In DSAEK, on the other hand, the thin layer of endothelium comes with some stroma; UT-DSAEK uses even thinner layers than DSAEK. DMEK is preferred versus DSAEK for better visual outcomes and quicker recovery, although the former is a more difficult surgery and is prone to the graft not taking.

In this prospctive, multicenter randomized controlled trial, a total of 54 pseudophakic eyes from 54 patients were enrolled. The study was conducted in the Netherlands and focused on patients wih Fuchs endothelial dystrphy. The objective was to compare the best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), refractive astigmatism, and complications after DMEK and UT-DSAEK.

Results showed that there were no significant differences in BSCVA between the two treatment groups at 3, 6, and 12 months. However, the percentage of eyes achieving 20/25 Snellen vision was significantly higher in DMEK patients. There were also no differences in endothelial cell loss, and both techniques resulted in a minimal hyperopic shift

Dunker, S., Dickman, M., Wisse, R., Nobacht, S., Wijdh, R., & Bartels, M. et al. (2020). Descemet Membrane Endothelial Keratoplasty versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty. Ophthalmology.

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