Descemet's membrane endothelial keratoplasty (DMEK) versus Descemet's stripping automated endothelial keratoplasty (DSAEK) for corneal endothelial failure

Stuart, Alastair; Romano, Vito; Virgili, Gianni; Shortt, Alex J.

doi:10.1002/14651858.cd012097.pub2

Cited by 122 publications

(155 citation statements)

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“…In addition, in general higher graft detachment rate of the thinner DMEK, resembling the handling of the DSEK graft, was reported compared to DS(A)EK (Stuart et al. ). In general, thinner grafts have different properties than thicker grafts and are subsequently more difficult to handle, as is reported for DMEK grafts (Li et al.…”

Section: Discussionmentioning

confidence: 98%

Prospective evaluation of clinical outcomes between pre‐cut corneal grafts prepared using a manual or automated technique: with one‐year follow‐up

Muijzer

Luijk

Bogaerdt

et al. 2019

Acta Ophthalmologica

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PurposePosterior lamellar corneal surgery is considered the standard of care for irreversible endothelial cell dysfunction. Pre‐cut grafts can be prepared either manually (Descemet stripping endothelial keratoplasty; DSEK) or mechanically (Descemet stripping automated endothelial keratoplasty; DSAEK). We performed a head‐to‐head clinical comparison between DSEK and DSAEK grafts.MethodsAll DSEK and DSAEK procedures performed by two corneal specialists at the University Medical Center Utrecht from 1 January 2016 through 31 October 2016 were prospectively included. Pre‐cut grafts were delivered by two eye banks, which either exclusively prepared the DSEK or DSAEK grafts. Preoperative and postoperative measurements were obtained, and all surgical events and adverse events were recorded.ResultsA total of 21 DSEK and 53 DSAEK procedures were included for analysis; the two groups were similar at baseline, with the exception of graft endothelial cell density, which was 2531 ± 67 versus 2748 ± 148 cells/mm2, respectively (p < 0.001). At the one‐year follow‐up visit, corrected distance visual acuity and endothelial cell loss were similar between the groups. Mean pachymetry was significantly lower in the DSEK group (521 ± 39 versus 588 ± 59 μm; p < 0.001), whereas the rebubbling rate was significantly higher in the DSEK group (47.6% versus 18.9%; p = 0.001). Finally, three grafts in the DSEK group experienced failure compared to one graft in the DSAEK group (14% versus 1.9%, respectively).ConclusionManually dissected and microkeratome‐dissected grafts performed similarly with respect to vision and endothelial cell loss assessed one year after surgery. The higher incidence of graft failure among manually dissected (i.e. DSEK) grafts may be attributable to reduced relative thickness compared to DSAEK grafts and/or the resulting differences in tissue handling and the surgeon's learning curve.

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Section: Discussionmentioning

confidence: 98%

Prospective evaluation of clinical outcomes between pre‐cut corneal grafts prepared using a manual or automated technique: with one‐year follow‐up

Muijzer

Luijk

Bogaerdt

et al. 2019

Acta Ophthalmologica

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“…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%

“…Due to its quicker postoperative recovery and similar or better visual outcome and lower rejection rates, DMEK has rapidly gained popularity even though its widespread adoption is still limited by the difficult and less predictable surgical technique that prevents its use in complicated cases, and by its higher rates of postoperative rebubbling [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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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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“…Descemet's membrane endothelial keratoplasty (DMEK) currently offers the greatest opportunity of visual gain to patients suffering from endothelial dysfunction. 1,2 However, partial graft detachment after DMEK remains a burden for patients and a challenge for surgeons, with detachments requiring air injection in 3% to 76% of cases. 3,4 Anterior segment optical coherence tomography (AS-OCT) allows for visualization of early graft detachment and is therefore clinically useful in guiding postoperative care.…”

Section: Introductionmentioning

confidence: 99%

Quantifying Graft Detachment after Descemet's Membrane Endothelial Keratoplasty with Deep Convolutional Neural Networks

Heslinga

Alberti

Pluim

et al. 2020

Trans. Vis. Sci. Tech.

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We developed a method to automatically locate and quantify graft detachment after Descemet's membrane endothelial keratoplasty (DMEK) in anterior segment optical coherence tomography (AS-OCT) scans. Methods: A total of 1280 AS-OCT B-scans were annotated by a DMEK expert. Using the annotations, a deep learning pipeline was developed to localize scleral spur, center the AS-OCT B-scans and segment the detached graft sections. Detachment segmentation model performance was evaluated per B-scan by comparing (1) length of detachment and (2) horizontal projection of the detached sections with the expert annotations. Horizontal projections were used to construct graft detachment maps. All final evaluations were done on a test set that was set apart during training of the models. A second DMEK expert annotated the test set to determine interrater performance. Results: Mean scleral spur localization error was 0.155 mm, whereas the interrater difference was 0.090 mm. The estimated graft detachment lengths were in 69% of the cases within a 10-pixel (∼150 μm) difference from the ground truth (77% for the second DMEK expert). Dice scores for the horizontal projections of all B-scans with detachments were 0.896 and 0.880 for our model and the second DMEK expert, respectively. Conclusions: Our deep learning model can be used to automatically and instantly localize graft detachment in AS-OCT B-scans. Horizontal detachment projections can be determined with the same accuracy as a human DMEK expert, allowing for the construction of accurate graft detachment maps. Translational Relevance: Automated localization and quantification of graft detachment can support DMEK research and standardize clinical decision-making.

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Descemet's membrane endothelial keratoplasty (DMEK) versus Descemet's stripping automated endothelial keratoplasty (DSAEK) for corneal endothelial failure

Cited by 122 publications

References 62 publications

Prospective evaluation of clinical outcomes between pre‐cut corneal grafts prepared using a manual or automated technique: with one‐year follow‐up

Prospective evaluation of clinical outcomes between pre‐cut corneal grafts prepared using a manual or automated technique: with one‐year follow‐up

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

Quantifying Graft Detachment after Descemet's Membrane Endothelial Keratoplasty with Deep Convolutional Neural Networks

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