Comparison of Visual Acuity Outcomes Between Nanothin Descemet Stripping Automated Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty

Kurji, Khaliq; Cheung, Albert Y.; Eslani, Medi; Rolfes, Erin J; Chachare, Deepali Y.; Auteri, Nicholas J; Nordlund, Michael L.; Holland, Edward J.

doi:10.1097/ico.0000000000001697

Cited by 41 publications

(57 citation statements)

References 33 publications

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“…While Bhandari et al [21] and Chamberlain et al [17] found better visual outcomes after DMEK compared to UT-DSAEK, Tourabaly et al [22] found similar BCVA between DMEK, UT-DSAEK and NT-DSAEK and Kurji et al [16] between DMEK and NT-DSAEK.…”

Section: Discussionmentioning

confidence: 99%

“…DMEK and DSAEK are the two most widely performed endokeratoplasty techniques for the treatment of endothelial dysfunctions. Even though there is evidence that DMEK may give equal or better results than "conventional" DSAEK (with grafts thicker than 130 μm and a faster recovery time [1,[5][6][7][8][9][10], few studies have directly compared the visual outcomes between UT-DSAEK and DMEK [16,17,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…These outcomes were further supported by a large interventional case series [14] and by a recent randomized controlled clinical trial [4]. Thus, due to the higher demand and thanks to the refinement and standardization of graft cutting techniques [3,14,15], eye banks nowadays are providing surgeons with thinner grafts, often thinner than 100 μm (ultrathin) or 50 μm (nanothin) [3,16]. The increasing availability of ultrathin grafts has led to a randomized controlled clinical study [17] which found a higher visual outcome after DMEK compared to UT-DSAEK.…”

Section: Introductionmentioning

confidence: 94%

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Ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a fellow-eye comparison

et al. 2020

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Background: To compare the visual outcome and patients' satisfaction after ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) performed on fellow eyes of the same patients. Methods: In this retrospective study, the records of 18 pseudophakic patients affected by Fuchs endothelial dystrophy who underwent DMEK in one eye and UT-DSAEK in the fellow eye were reviewed. Best corrected visual acuity (BCVA), corneal pachymetry, keratometry, corneal aberrations, photopic and mesopic contrast sensitivity, and endothelial cell counts measured 12 months after surgery in either eye were analyzed and compared. The results of a satisfaction questionnaire were also reviewed. Results: Twelve months after surgery, BCVA was not significantly different in UT-DSAEK and DMEK eyes (0.10 ± 0.04 and 0.07 ± 0.07 logMAR, respectively); at both 4-and 6 mm optical zones total and posterior corneal higher order aberrations (HOAs), posterior astigmatism and total coma were significantly lower after DMEK; BCVA in both groups was significantly correlated mainly with anterior corneal aberrations; contrast sensitivity was higher after DMEK especially in mesopic conditions and at medium spatial frequencies; the endothelial cell density was similar, although slightly higher in the UT-DSAEK group (p = 0.10). The satisfaction questionnaire showed that although patients were highly satisfied from both procedures, more than half of them preferred DMEK and reported a more comfortable and quicker postoperative recovery. Conclusions: DMEK and UT-DSAEK showed no evidence of difference in terms of postoperative BCVA, although DMEK had a better performance in terms of contrast sensitivity, posterior corneal aberrations and overall patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

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Ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a fellow-eye comparison

et al. 2020

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“…The use of modified techniques with both automated and manual microkeratomes has enabled surgeons to perform ultra-thin DSAEK with faster visual recovery and superior visual outcomes 2–4. Moreover, DSAEK has the advantage of an easier learning curve and less tissue loss during donor preparation than DMEK 5.…”

Section: Introductionmentioning

confidence: 99%

‘Acute-angled bevel’ sign to assess donor lenticule orientation in ultra-thin descemet stripping automated endothelial keratoplasty

Titiyal¹,

Kaur

Shaikh

et al. 2019

BMJ Case Rep

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A 6.5-year-old boy with congenital hereditary endothelial dystrophy underwent clear corneal ultra-thin descemet stripping automated endothelial keratoplasty (DSAEK). After graft insertion, it was difficult to assess graft orientation due to hazy cornea. Intraoperative optical coherence tomography (iOCT) showed a well-attached graft and the bevelled edge of donor lenticule made an acute angle with the overlying stroma. Postoperative anterior segment OCT confirmed the presence of acute-angled bevel sign. A wetlab experiment was performed with experimental corneoscleral tissues to confirm the findings. Donor lenticule was injected in the artificial chamber with stromal-side up as well as stromal side-down. ‘Acute-angled bevel sign’ was observed on iOCT in the experimental cases with stromal-side up. In inverse graft, the acute-angled bevel was not observed, instead the configuration was obtuse angled. Identifying the ‘acute-angled bevel sign’ on iOCT confirms correct graft orientation after unfolding and is extremely useful for hazy corneas and ultrathin DSAEK lenticules.

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“…Newer modifications to DSAEK have created thinner grafts. Ultrathin DSAEK (UT-DSAEK) (60-90 lm grafts) and nanothin DSAEK (NT-DSAEK) (grafts 50 lm or thinner) have been shown to have improved visual outcomes with faster visual recovery than standard DSAEK [17][18][19][20].…”

Section: Descemet Stripping Automated Endothelial Keratoplastymentioning

confidence: 99%

Update on the Surgical Management of Fuchs Endothelial Corneal Dystrophy

Blitzer

Colby

2020

Ophthalmol Ther

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Fuchs endothelial corneal dystrophy (FECD) is the most common posterior corneal dystrophy and the leading indication for corneal transplantation in the United States. FECD is slowly progressive, and patients develop gradual corneal endothelial decompensation, eventually resulting in failure of the endothelium to maintain corneal deturgescence. Medical management consists of topical hyperosmotic agents to facilitate dehydration of the cornea, but surgical intervention is often required to regain corneal clarity. The surgical management of FECD has evolved over the past two decades as corneal transplantation techniques have allowed for more selective keratoplasty and replacement of only the diseased layers of the cornea. Prior surgical management consisted of penetrating keratoplasty (PK) that carried significant intraoperative risks associated with ''open sky'' as well as postoperative risks of graft rejection, wound dehiscence, postoperative astigmatism, and prolonged visual rehabilitation. In the past 15 years, endothelial keratoplasty (EK) has become the treatment of choice for endothelial disease, significantly reducing the risks associated with the surgical treatment of FECD. Here we discuss the current surgical management of FECD, including the introduction of Descemet stripping only (DSO), and highlight future investigative efforts.

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Comparison of Visual Acuity Outcomes Between Nanothin Descemet Stripping Automated Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty

Abstract: Compared with DMEK, NT-DSAEK provides comparable visual outcomes and complications rates.

Cited by 41 publications

References 33 publications

Ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a fellow-eye comparison

Ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a fellow-eye comparison

‘Acute-angled bevel’ sign to assess donor lenticule orientation in ultra-thin descemet stripping automated endothelial keratoplasty

Update on the Surgical Management of Fuchs Endothelial Corneal Dystrophy

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