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

Abstract

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.

Correlation Between the Cost and Safety of Corneal Graft Types

“…Types and major characteristics of the surgical operations that the patients underwent are presented in Table 3 . Reoperation was needed in 14% of the cases, while 7.6% of the cases were surgeries that occurred due to graft rejection [ 26 , 27 ] or a non-functioning graft from a surgery performed at another hospital or clinic. In the majority of the surgeries (60.8%), a Descemet’s stripping automated endothelial keratoplasty (DSAEK) graft was used.…”

Ultrathin DSAEK versus DMEK – Review of systematic reviews

“…Four full-text articles were retrieved and analyzed after the initial screening of titles and abstract, and all four SRs were eligible for inclusion. 12–15 The PRISMA study flow diagram is presented in Supplemental Figure 1.…”

“…12 This was different than the pooled MD estimates from the other three studies, who observed pooled MD of 0.06-0.07 in BCVA. [13][14][15] Dimtsas et al also performed a meta-analysis of the 12-month SphEq and found a pooled estimate favoring DMEK over UT-DSAEK (MD = −0.12, 95%CI = −0.42-0.00, p = 0.049); however, heterogeneity analysis for this outcome was not presented by the authors. 13 The study by Singh et al observed high heterogeneity in their BCVA meta-analysis, which the authors considered to be likely due to the differences in postoperative time points analyzed in the studies included.…”

“…[13][14][15] Dimtsas et al also performed a meta-analysis of the 12-month SphEq and found a pooled estimate favoring DMEK over UT-DSAEK (MD = −0.12, 95%CI = −0.42-0.00, p = 0.049); however, heterogeneity analysis for this outcome was not presented by the authors. 13 The study by Singh et al observed high heterogeneity in their BCVA meta-analysis, which the authors considered to be likely due to the differences in postoperative time points analyzed in the studies included. 14 The SR by Hurley et al concluded that the level of quality of evidence for the BCVA analysis was "High" using the GRADE system.…”

“…The studies by Dimtsas et al, Singh et al and Hurley et al performed meta-analyses to compare DMEK and UT-DSAK in "overall complications" (Table 5). [13][14][15] The largest difference in complication rate was reported by Singh et al, who observed that patients undergoing UT-DSAEK had 73% less risk of postoperative complications compared with patients undergoing DMEK (OR = 0.27, 95%CI = 0.12-0.59, p = 0.001). 14 Hurley et al concluded that UT-DSAEK was associated with 43% less risk of complications compared with DMEK (RR = 0.57, 95%CI = 0.36-0.90, p = 0.02), 15 and Dimtsas et al reported a 1.49-fold increased risk of complications after DMEK (RR = 1.49, 95%CI = 1.02-4.49, p = 0.039).…”