Clinical outcomes of pre-loaded ultra-thin DSAEK and pre-loaded DMEK

Romano, Vito; Pagano, Luca; Gadhvi, Kunal A; Coco, Giulia; Titley, Mitchell; Fenech, Matthew; Ferrari, Stefano; Levis, Hannah J.; Parekh, Mohit; Kaye, Stephen B.

doi:10.1136/bmjophth-2020-000546

Cited by 31 publications

(37 citation statements)

References 29 publications

(32 reference statements)

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“…Due to rarity of FED cases in Asia, inevitably, the indications for surgery have diversified. Given that there are other studies that have been conducted with various surgical indications, so our study also worthy to compare the clinical outcomes [ 36 , 56 – 58 ]. In addition, the follow-up durations differed between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) with imported donor corneas in eyes of Asian patients; endothelium‐in versus endothelium‐out method

2022

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Objective We investigated whether (1) imported pre-cut tissue is feasible for Descemet membrane endothelial keratoplasty (DMEK) in eyes of Asian patients, (2) the clinical outcome is comparable between the endothelium‐in and endothelium‐out methods, and (3) the corneal edema-induced anterior curvature changes may have an effect on the refractive error. Methods The medical records of 32 DMEK patients who underwent either the endothelium-out or endothelium-in method using imported pre-cut grafts with a 3-day pre-cut-to-use time were retrospectively analyzed. Fuchs’ endothelial dystrophy (37.5%) and bullous keratopathy (62.5%) cases were included. The main clinical outcome measures were graft survival, best corrected visual acuity (BCVA), endothelial cell density (ECD), corneal thickness (CT), and complications. Correlation of the anterior curvature changes with refractive error was analyzed in the DMEK with cataract surgery group. Results The overall survival rate was 71.9%. Final graft failures were caused by rejection, glaucoma, and infection. Visual acuities improved by 89.3%. BCVA better than 20/40 and 20/20 was found in 75% and 28.6% of patients, respectively. The ECDs at 3 months and 1 year were 1400 and 1083 cells/mm2, respectively. The mean survival time, ECD, BCVA, CT, and complication rates were not different between the endothelium-in and endothelium-out methods. A hyperopic shift by +0.42 D was not related to the anterior curvature changes. Conclusion Imported pre-cut tissues with a ≤ 3-day pre-cut-to-use time are feasible for DMEK in the treatment of corneal endothelial edema in eyes of Asian patients, and both endothelium-in and endothelium-out methods appear to be comparatively effective. Edema-induced anterior curvature change may not affect the refractive shift.

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Section: Discussionmentioning

confidence: 99%

Clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) with imported donor corneas in eyes of Asian patients; endothelium‐in versus endothelium‐out method

2022

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“… 20 Similarly, Romano and colleagues, reported a post-operative VA of 0.37 ± 0.37 and 0.17 ± 0.2 in UT-DSAEK and DMEK groups, respectively. 21 Interestingly, Torras-Sanvicens and colleagues reported moderately better VA outcomes in patients who underwent UT-DSAEK (0.16 ± 0.14) compared to DMEK (0.21 ± 0.29). 22 …”

Section: Primary Outcomesmentioning

confidence: 96%

Is ultra-thin Descemet stripping automated endothelial keratoplasty a viable alternative to Descemet membrane endothelial keratoplasty? A systematic review and meta-analysis

et al. 2023

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Background: Ultra-thin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) is a recently developed surgical procedure that has shown promising results for the management of various corneal endothelial diseases. Objectives: To evaluate the outcomes of the UT-DSAEK to the Descemet membrane endothelial keratoplasty (DMEK). Design: A systematic analysis of the studies comparing UT-DSAEK with DMEK by evaluating one or more outcomes (vision, complications, and post-operative endothelial cell counts) was performed. The meta-analysis was done if two or more studies reported a common outcome. Methods: We used PubMed, EMBASE, and SCOPUS databases to identify articles comparing the outcomes of UT-DSAEK with DMEK and performed a meta-analysis using RevMan, version 5.4. Results: A total of six studies were included in this review (two randomized clinical trials and four non-randomized comparative studies). Our analysis showed the patients who underwent DMEK cases showed better visual outcomes with a mean difference of 0.06 LogMAR (95% CI: 0.04–0.09) in BCVA, albeit with i2 of 52% (heterogenous values). The evidence was weak, with the most weightage on retrospective studies. UT-DSAEK showed significantly fewer complications such as graft dislocations, with an odds ratio of 0.25 (95% CI: 0.13–0.48). There was no significant difference in the endothelial cell counts with a mean difference of 86.34 (95%CI: –133.09 to –305.77). Conclusion: Although the literature is limited on UT-DSAEK with post-operative visual acuity that could be practically at par with DMEK, lesser complication rates and comparable post-operative endothelial cells could be a suitable alternative to DMEK for corneal endothelial pathologies.

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“…Thirty-three of the 39 remaining articles did not present usable data. Finally, six studies were eligible based on the inclusion criteria and selected for this meta-analysis (16)(17)(18)(19)(20)(21). Figure 1 demonstrates the Preferred Reporting Items for systematic review and meta-analyses (PRISMA) study flow diagram.…”

Section: Resultsmentioning

confidence: 99%

Ultrathin-Descemet Stripping Automated Endothelial KeratoplastyVersusDescemet Membrane Endothelial Keratoplasty: A Systematic Review and Meta-analysis

Dimtsas

Moschos

2023

In Vivo

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Background/Aim: The aim of this meta-analysis was to compare the efficacy and safety of Ultrathin -Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus Descemet membrane endothelial keratoplasty (DMEK) for the treatment of corneal endothelial failure in patients with Fuchs endothelial dystrophy (FED) or Pseudophakic bullous keratopathy (PBK). Patients and Methods: We performed a meta-analysis and conducted a literature search in PubMed and Cochrane Library, following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Effects were calculated as odds ratios or standardized mean differences. Results: A total of six studies with 300 eyes in total (151 UT-DSAE and 149 DMEK) were included. BSCVA was superior in the DMEK group compared with the UT-DSAEK at 3, 6, and 12 months after surgery. Rebubbling rates and overall adverse events were 2.37 and 1.48 times, respectively, higher in the DMEK group. The central corneal thickness and spherical equivalent were significantly lower in the DMEK group 12 months post-surgery. Endothelial cell density values were similar in both groups up to 12 months postoperatively. Conclusion: To the best of our knowledge, this is the first meta-analysis comparing UT-DSAEK with DMEK. DMEK surgery resulted in significantly better BSCVA at 3, 6, and 12 months postoperatively compared to UT-DSAEK. UT-DSAEK had a better complication profile with lower rebubbling rates.

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Clinical outcomes of pre-loaded ultra-thin DSAEK and pre-loaded DMEK

Cited by 31 publications

References 29 publications

Clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) with imported donor corneas in eyes of Asian patients; endothelium‐in versus endothelium‐out method

Clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) with imported donor corneas in eyes of Asian patients; endothelium‐in versus endothelium‐out method

Is ultra-thin Descemet stripping automated endothelial keratoplasty a viable alternative to Descemet membrane endothelial keratoplasty? A systematic review and meta-analysis

Ultrathin-Descemet Stripping Automated Endothelial KeratoplastyVersusDescemet Membrane Endothelial Keratoplasty: A Systematic Review and Meta-analysis

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