Research ArticleClinical Studies
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Ultrathin-Descemet Stripping Automated Endothelial Keratoplasty Versus Descemet Membrane Endothelial Keratoplasty: A Systematic Review and Meta-analysis

GEORGIOS S. DIMTSAS and MARILITA M. MOSCHOS
In Vivo January 2023, 37 (1) 400-409; DOI: https://doi.org/10.21873/invivo.13092

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.

Key Words:

Endothelial keratoplasty (EK) is defined as the selective replacement of dysfunctional endothelium with donor endothelial grafts. Over the last two decades, EK tends to replace penetrating keratoplasty (PK) in cases involving endothelial decompensation of various origins, such as Fuchs endothelial dystrophy (FED) or Pseudophakic bullous keratopathy (PBK) (1). The reason is that EK results in faster vision recovery, reduced graft rejection rates and faster recovery time (2).

The two main techniques of EK are Descemet stripping automated endothelial keratoplasty (DSAEK) (3) and Descemet membrane endothelial keratoplasty (DMEK) (4). In DSAEK, the diseased endothelium and the Descemet membrane are removed and replaced by healthy endothelium with the underlying Descemet membrane and a stroma layer of variable thickness (3). On the contrary, in DMEK, the donor tissue consists only of endothelium and Descemet membrane (4). Several studies and meta-analyses have shown the superiority of DMEK over DSAEK in terms of visual outcome and patient satisfaction (5-9).

In 2011, Neff et al. reported that thinner DSAEK grafts could result in a better visual outcome (10). The above evidence led to the introduction of Ultrathin-DSAEK (UT-DSAEK), where the thickness of the corneal grafts is ≤100 μm (11). Studies have shown that UT-DSAEK results in faster and better recovery of Best Spectacle-corrected Visual Acuity (BSCVA) than the conventional DSAEK with a similar incidence of complications as the conventional DSAEK (12, 13).

The aim of the current meta-analysis was to compare the effectiveness and safety of UT-DSAEK versus DMEK for the treatment of corneal endothelial failure in patients with FED and PBK.

Patients and Methods

Search strategy and selection criteria. We (G.D & M.M) conducted a literature search on the following electronic databases: PubMed and the Cochrane Library with the last run in September 2022. The search strategy combined the keywords “Ultrathin Descemet stripping automated endothelial keratoplasty” or “UT-DSAEK” AND “Descemet membrane endothelial keratoplasty” or “DMEK”. Additionally, manual detection of the possible studies was performed using the obtained articles’ reference lists.

All the relevant studies, which compared UT-DSAEK versus DMEK, were included in this systematic review. The inclusion criteria of this study were as follows: 1) Comparative studies, including randomized control trials and prospective or retrospective cohort studies. 2) Patients with FED or PBK who underwent UT-DSAEK or DMEK, triple procedures were included. 3) Studies that mentioned at least one of the outcomes of interest: postoperative logarithm of the minimum angle of resolution (logMAR) best spectacle-corrected visual acuity (BSCVA), spherical equivalent, endothelial cell density (ECD), central corneal thickness (CCT), and adverse events. The exclusion criteria were: 1) Non-comparative studies, 2) eyes included with ocular comorbidities except from FED or PBK, 3) studies not written in English. The Newcastle-Ottawa Scale was used to assess the risk for bias of the studies.

Data extraction. Data were extracted independently by two reviewers (G.D and M.M) from each eligible study. The information that was extracted from all included studies were: the name of the first author, year of publication, location, he study design, total number (N) of patients that were enrolled in each study, number (N) of patients with FED or PBK in each study, number of patients (N) that underwent UT-DSAEK or DMEK, age of patients, preoperative and postoperative logMAR BSCVA, pre- and postoperative spherical equivalent, pre- and postoperative endothelial cell density, postoperative central corneal thickness, and proportion of patients with rebubbling, graft rejection and other adverse events. All disagreements regarding data extraction were resolved through discussion.

Statistical analysis. The present systematic review and meta-analysis were conducted in accordance with the recommendations of the Cochrane Library and PRISMA guidelines. Random and fixed effects meta-analysis was conducted for the study outcomes. A random effects model was used to calculate the pooled mean differences (MD) or relative risks (RR) in case of significant between-study heterogeneity, and a fixed effects model was used in case of non-significant between-study heterogeneity (14). Heterogeneity between studies was assessed using the I2 in order to determine the degree of variation not attributable to chance alone. If I2 values were more than 50%, we considered the data significantly heterogeneous (15). Statistical significance was considered when p<0.05. All statistical analyses were performed in the STATA software version 11.0.

Results

Study selection. In total, 67 articles were identified initially by searching the PubMed and the Cochrane Library. Subsequently, 22 duplicates were removed and 45 articles were assessed for detailed evaluation. After an independent review, six articles were excluded after full-text evaluation. 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 (16-21). Figure 1 demonstrates the Preferred Reporting Items for systematic review and meta-analyses (PRISMA) study flow diagram.

Figure 1.
Figure 1.

PRISMA study flow diagram.

Characteristics of included studies and quality assessment. The six studies that were included in the analysis and their characteristics are presented in Table I and Table II. Regarding study site distribution, 2 studies were from the United Kingdom, 1 from the United States of America, 1 from the Netherlands, 1 from Italy, and 1 from Poland. The range of research periods was between 2019 and 2021. In total, 151 participants underwent UT-DSAEK and 149 DMEK. The mean number of participants was 25.2 (SD=4.4) for UT-DSAEK and 24.8 (SD=3.9) for DMEK. The most frequent diagnosis was FED in both procedures.

View this table:
Table I.

Studies included in the meta-analysis.

View this table:
Table II.

Studies’ characteristics.

The quality of the included studies was high according to the Newcastle-Ottawa Scale, as all studies received 7 out of 9 points (Table I).

Best spectacle-corrected visual acuity. Overall mean preoperative BSCVA was similar between DMEK and UT-DSAEK, (MD=0.028, 95%CI=−0.037-0.094; p=0.399). At three months, patients with UT-DSAEK had a mean BSCVA of 0.22 (95%CI=0.065-0.37), whereas patients with DMEK had a mean BSCVA of 0.14 (95%CI=0.005-0.28).

As depicted in Figure 2, based on the meta-analysis of the results from the three included studies, the pooled mean difference of BSCVA between DMEK and UT-DSAEK, at three months, was found to be equal to −0.08 (95%CI=−0.12-0.03). The between-study heterogeneity was not significant (overall Q=1.41, p=0.493, I2=0.0) and a fixed effects model was used to calculate the pooled estimates. The BSCVA at three months was significantly lower in DMEK cases as compared to UT-DSAEK cases (p=0.001).

Figure 2.
Figure 2.

Results from the fixed effects meta-analysis concerning the difference of Best Spectacle-Corrected Visual Acuity (BSCVA) at three months between Descemet membrane endothelial keratoplasty (DMEK) and Ultrathin – Descemet stripping automated endothelial keratoplasty (UT-DSAEK).

Pooled estimates of the mean difference of BSCVA between DMEK and UT-DSAEK at 6 months are shown in Figure 3. The between-study heterogeneity was significant, and the random effects model showed a pooled mean difference equal to −0.097 (95%CI=−0.16-0.03) in favor of DMEK (p=0.003). At 12 months, the pooled mean difference of BSCVA (overall Q=7.84, p=0.097, I2=49%, estimated from five studies) between DMEK and UT-DSAEK (Figure 4) was equal to −0.075 (95%CI=−0.12-0.03), again in favor of DMEK (p=0.001).

Figure 3.
Figure 3.

Results from the fixed effects meta-analysis concerning the difference of Best Spectacle-corrected visual acuity (BSCVA) at six months between Descemet membrane endothelial keratoplasty (DMEK) and Ultrathin – Descemet stripping automated endothelial keratoplasty (UT-DSAEK).

Figure 4.
Figure 4.

Results from the meta-analysis concerning the difference of Best spectacle-corrected visual acuity (BSCVA) at 12 months between Descemet membrane endothelial keratoplasty (DMEK) and Ultrathin – Descemet stripping automated endothelial keratoplasty (UT-DSAEK).

Endothelial cell density. Overall mean preoperative ECD was similar between DMEK and UT-DSAEK (MD=−7.14; 95%CI=−51.0-36.7; p=0.750). At three months, ECD was recorded only in two studies and pooled mean difference between DMEK and UT-DSAEK was equal to −126.6 (95%CI=−300.7-553.8), p=0.561. At six months, ECD was recorded from three studies and pooled mean difference between DMEK and UT-DSAEK was not significant (MD=−61.6; 95%CI=−177.9-300.8), p=0.614. Pooled estimates of the mean difference of ECD between DMEK and UT-DSAEK at 12 months are shown in Figure 5. The between-study heterogeneity was significant and the random effects model showed a pooled non-significant (p=0.900) mean difference that was equal to −14.0 (95%CI=−233.3-205.3).

Figure 5.
Figure 5.

Results from the meta-analysis concerning the difference of Endothelial cell density (ECD) at 12 months between Descemet membrane endothelial keratoplasty (DMEK) and Ultrathin – Descemet stripping automated endothelial keratoplasty (UT-DSAEK).

Spherical equivalent. Mean preoperative spherical equivalent (EQ) was well balanced between DMEK and UT-DSAEK, (MD=0.22, 95%CI=−0.59-1.05; p=0.586). At six months, spherical EQ was referred to in only two studies and pooled mean difference between DMEK and UT-DSAEK was not significant [MD=−0.24 (95%CI=−0.74-0.26) p=0.349]. At 12 months, a significant (p=0.049) pooled mean difference between DMEK and UT-DSAEK for spherical EQ was estimated from a fixed effects model [MD=−0.21 (95%CI=−0.42-0.00)], indicating lower values for DMEK (Figure 6).

Figure 6.
Figure 6.

Results from the meta-analysis concerning the difference of spherical equivalent at 12 months between Descemet membrane endothelial keratoplasty (DMEK) and Ultrathin – Descemet stripping automated endothelial keratoplasty (UT-DSAEK).

Central corneal thickness. CCT at 12 months was evaluated in two studies and found to be significantly lower in DMEK cases as compared to UT-DSAEK cases. The pooled estimated difference between DMEK and UT-DSAEK at 12 months was −47.1 (95%CI=−62.2-32.0), p<0.001.

Adverse events. Concerning the rebubbling rates, the DMEK group needed rebubbling procedures 2.37 times more often as defined by a fixed effects model (RR=2.37, 95%CI=1.25-4.49), p=0.008; Figure 7). Donor preparation failure was reported in 2 cases in the UT-DSAEK group (16, 17) and in 3 cases in the DMEK group (16, 17, 19). One study reported that three DMEK cases needed retransplantation (17). The risk of elevated IOP was not different between DMEK and UT-DSAEK cases (RR=0.91, 95%CI=0.45-1.78, p=0.790). Graft rejection was reported only in one (3.5%) DMEK case (19). Overall, the DMEK group had 1.48 times greater risk for adverse events, as defined from a fixed effects model (RR=1.49, 95%CI=1.02-2.16, p=0.039; Figure 8).

Figure 7.
Figure 7.

Results from the meta-analysis concerning the risk for rebubbling.

Figure 8.
Figure 8.

Results from the meta-analysis concerning the risk for any adverse event.

Discussion

This meta-analysis included 6 studies, enrolling a total of 300 eyes. Especially, 151 eyes underwent UT-DSAEK and 149 eyes underwent DMEK for either FED or PBK. All the eyes included did not have any other ocular comorbidity. The mean Central Graft Thickness for the UT-DSAEK group was 78.5 μm, which is in accordance with the definition of the UT-DSAEK graft (≤100 μm) (11).

Concerning the visual rehabilitation, we found that DMEK resulted in better BSCVA than UT-DSAEK at 3, 6, and 12 months postoperatively, and the difference was statistically significant. Our results are in accordance with previous meta-analyses that compared DSAEK with DMEK and they found a superiority of DMEK (6-9). This visual superiority could be explained by the development of higher-order aberrations (HOAs) after conventional DSAEK or UT-DSAEK. A recent study has shown that the posterior corneal HOAs are strongly correlated with postoperative BSCVA at 6 and 12 months after DMEK or UT-DSAEK than anterior corneal HOAs (22). Especially they have reported that the posterior corneal HOAs are reduced after DMEK and increased after UT-DSAEK at least up to 12 months after transplantation (22). The increase in posterior corneal HOAs can be explained by the donor-recipient curvature mismatch (23), graft asymmetry (24) and graft folds (25).

Our results show that both techniques treat well the endothelial cells, as there is no difference in the ECD between UT-DSAEK and DMEK up to 12 months after surgery. These results are in accordance with previous studies (26, 27). Additionally, the spherical EQ and central corneal thickness were lower in the DMEK group compared with the UT-DSAEK group, 12 months after the surgery. That can be explained by the nature of the UT-DSAEK technique where the graft is thicker than the DMEK graft.

Regarding the adverse events, an interesting finding of the current meta-analysis is that the rebubbling rates were 2.37 times higher in the DMEK group in comparison with the UT-DSAEK group and that the difference was significant. Previous studies have reported different rates of rebubbling in DMEK ranging from 2% to 82% (28, 29). On the contrary, in a large cohort of UT-DSAEK cases, the rebubbling rate was 4% (27). Overall, we report that UT-DSAEK shows a better safety profile as the overall rate of adverse events is higher by 1.48 times in the DMEK group in comparison with the UT-DSAEK group.

The present meta-analysis has one limitation, which is the small number of studies included. Only six studies met the inclusion criteria, but only one was retrospective. Three of them were randomized controlled trials and two were comparative studies, which provide more strength to our results.

To the best of our knowledge, the present meta-analysis is the first in the literature that compares exclusively UT-DSAEK and DMEK in terms of efficacy and safety in patients with FED or PBK and with no other ocular comorbidities. In parallel with us, another team worked on the same topic and they managed to publish their meta-analysis earlier (30). Even if our results are similar, we have to mention that they have included in the UT-DSAEK group, 28 patients that underwent Nanothin-DSAEK (NT-DSAEK) (31). NT-DSAEK is a newer modification of DSAEK, where the graft thickness is ≤50 μm (32), which is considerably thinner compared to the UT-DSAEK graft which is ≤100 μm. We believe that the inclusion of patients that underwent NT-DSAEK should be avoided. The contribution of those 28 NT-DSAEK patients in a total of 165 UT-DSAEK patients (16.9%) could alter the final outcome. Especially, when they estimated the BSCVA 6 months post-operatively, the NT-DSAEK patients were 28 out of 115 (24%). Previous studies have shown that graft thickness plays a crucial role in postoperative BSCVA (10, 33). Overall, NT-DSAEK seems to have comparable results to DMEK (31, 33).

Concluding, we have shown that DMEK is superior to UT-DSAEK concerning visual rehabilitation up to 12 months after surgery. Previous studies have shown that UT-DSAEK is superior to conventional DSAEK (12, 13). Additionally, we depict a better safety profile of UT-DSAEK compared with DMEK, especially with lower rebubbling rates. Taking into consideration our findings and in combination with previous studies (34-36), we believe that UT-DSAEK should be considered as the first-line intervention in endothelial dysfunction, especially by non-experienced surgeons, as it has an easier learning curve than DMEK and a good visual outcome with less adverse events than DMEK. On the contrary, DMEK provides better visual rehabilitation but it has a steeper learning curve, whilst it is difficult to perform DMEK in eyes with a shallow anterior chamber or complicated anatomy (37) and it has much higher rates of rebubbling, which demands extra intraocular manipulations that could be avoided.

In the future, more significant correlations could be extracted when more randomized controlled trials with more patients and a longer follow-up period will be performed.

Footnotes

  • Authors’ Contributions

    Dimtsas G. and Moschos M. collected the data, performed the statistical analysis, wrote, and revised the manuscript.

  • Conflicts of Interest

    The Authors have no conflicts of interest to declare in relation to this study.

  • Received November 6, 2022.
  • Revision received November 14, 2022.
  • Accepted November 15, 2022.

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY-NC-ND) 4.0 international license (https://creativecommons.org/licenses/by-nc-nd/4.0).

References

  1. ↵
    1. Price MO,
    2. Mehta JS,
    3. Jurkunas UV and
    4. Price FW Jr.
    : Corneal endothelial dysfunction: Evolving understanding and treatment options. Prog Retin Eye Res 82: 100904, 2021. PMID: 32977001. DOI: 10.1016/j.preteyeres.2020.100904
    OpenUrlCrossRefPubMed
  2. ↵
    1. Price FW Jr. and
    2. Price MO
    : Evolution of endothelial keratoplasty. Cornea 32 Suppl 1: S28-S32, 2013. PMID: 24104929. DOI: 10.1097/ICO.0b013e3182a0a307
    OpenUrlCrossRefPubMed
  3. ↵
    1. Gorovoy M
    : Descemet-stripping automated endothelial keratoplasty. Cornea 25(8): 886-889, 2021. DOI: 10.1097/01.ico.0000214224.90743.01
    OpenUrlCrossRef
  4. ↵
    1. Melles GR,
    2. Ong TS,
    3. Ververs B and
    4. van der Wees J
    : Descemet membrane endothelial keratoplasty (DMEK). Cornea 25(8): 987-990, 2006. PMID: 17102683. DOI: 10.1097/01.ico.0000248385.16896.34
    OpenUrlCrossRefPubMed
  5. ↵
    1. Bhandari V,
    2. Reddy JK,
    3. Relekar K and
    4. Prabhu V
    : Descemet’s stripping automated endothelial keratoplasty versus Descemet’s membrane endothelial keratoplasty in the fellow eye for Fuchs endothelial dystrophy: a retrospective study. Biomed Res Int 2015: 750567, 2015. PMID: 26636101. DOI: 10.1155/2015/750567
    OpenUrlCrossRefPubMed
  6. ↵
    1. Singh A,
    2. Zarei-Ghanavati M,
    3. Avadhanam V and
    4. Liu C
    : Systematic review and meta-analysis of clinical outcomes of Descemet membrane endothelial keratoplasty versus Descemet stripping endothelial keratoplasty/Descemet stripping automated endothelial keratoplasty. Cornea 36(11): 1437-1443, 2017. PMID: 28834814. DOI: 10.1097/ICO.0000000000001320
    OpenUrlCrossRefPubMed
    1. Zhu L,
    2. Zha Y,
    3. Cai J and
    4. Zhang Y
    : Descemet stripping automated endothelial keratoplasty versus descemet membrane endothelial keratoplasty: a meta-analysis. Int Ophthalmol 38(2): 897-905, 2018. PMID: 28417337. DOI: 10.1007/s10792-017-0533-3
    OpenUrlCrossRefPubMed
    1. Stuart AJ,
    2. Romano V,
    3. Virgili G and
    4. Shortt AJ
    : Descemet’s membrane endothelial keratoplasty (DMEK) versus Descemet’s stripping automated endothelial keratoplasty (DSAEK) for corneal endothelial failure. Cochrane Database Syst Rev 6: CD012097, 2018. PMID: 29940078. DOI: 10.1002/14651858.CD012097.pub2
    OpenUrlCrossRefPubMed
  9. ↵
    1. Marques RE,
    2. Guerra PS,
    3. Sousa DC,
    4. Gonçalves AI,
    5. Quintas AM and
    6. Rodrigues W
    : DMEK versus DSAEK for Fuchs’ endothelial dystrophy: A meta-analysis. Eur J Ophthalmol 29(1): 15-22, 2019. PMID: 29661044. DOI: 10.1177/1120672118757431
    OpenUrlCrossRefPubMed
  10. ↵
    1. Neff KD,
    2. Biber JM and
    3. Holland EJ
    : Comparison of central corneal graft thickness to visual acuity outcomes in endothelial keratoplasty. Cornea 30(4): 388-391, 2011. PMID: 21045647. DOI: 10.1097/ICO.0b013e3181f236c6
    OpenUrlCrossRefPubMed
  11. ↵
    1. Busin M,
    2. Patel AK,
    3. Scorcia V and
    4. Ponzin D
    : Microkeratome-assisted preparation of ultrathin grafts for descemet stripping automated endothelial keratoplasty. Invest Ophthalmol Vis Sci 53(1): 521-524, 2012. PMID: 22205600. DOI: 10.1167/iovs.11-7753
    OpenUrlAbstract/FREE Full Text
  12. ↵
    1. Busin M,
    2. Madi S,
    3. Santorum P,
    4. Scorcia V and
    5. Beltz J
    : Ultrathin descemet’s stripping automated endothelial keratoplasty with the microkeratome double-pass technique: two-year outcomes. Ophthalmology 120(6): 1186-1194, 2013. PMID: 23466268. DOI: 10.1016/j.ophtha.2012.11.030
    OpenUrlCrossRefPubMed
  13. ↵
    1. Dickman MM,
    2. Kruit PJ,
    3. Remeijer L,
    4. van Rooij J,
    5. Van der Lelij A,
    6. Wijdh RH,
    7. van den Biggelaar FJ,
    8. Berendschot TT and
    9. Nuijts RM
    : A randomized multicenter clinical trial of ultrathin Descemet stripping automated endothelial keratoplasty (DSAEK) versus DSAEK. Ophthalmology 123(11): 2276-2284, 2016. PMID: 27659544. DOI: 10.1016/j.ophtha.2016.07.036
    OpenUrlCrossRefPubMed
  14. ↵
    1. Berlin JA,
    2. Laird NM,
    3. Sacks HS and
    4. Chalmers TC
    : A comparison of statistical methods for combining event rates from clinical trials. Stat Med 8(2): 141-151, 1989. PMID: 2704896. DOI: 10.1002/sim.4780080202
    OpenUrlCrossRefPubMed
  15. ↵
    1. Higgins JP,
    2. Thompson SG,
    3. Deeks JJ and
    4. Altman DG
    : Measuring inconsistency in meta-analyses. BMJ 327(7414): 557-560, 2003. PMID: 12958120. DOI: 10.1136/bmj.327.7414.557
    OpenUrlFREE Full Text
  16. ↵
    1. Chamberlain W,
    2. Lin CC,
    3. Austin A,
    4. Schubach N,
    5. Clover J,
    6. McLeod SD,
    7. Porco TC,
    8. Lietman TM and
    9. Rose-Nussbaumer J
    : Descemet endothelial thickness comparison trial: a randomized trial comparing ultrathin Descemet stripping automated endothelial keratoplasty with Descemet membrane endothelial keratoplasty. Ophthalmology 126(1): 19-26, 2019. PMID: 29945801. DOI: 10.1016/j.ophtha.2018.05.019
    OpenUrlCrossRefPubMed
  17. ↵
    1. Dunker SL,
    2. Dickman MM,
    3. Wisse RPL,
    4. Nobacht S,
    5. Wijdh RHJ,
    6. Bartels MC,
    7. Tang ML,
    8. van den Biggelaar FJHM,
    9. Kruit PJ and
    10. Nuijts RMMA
    : Descemet membrane endothelial keratoplasty versus ultrathin Descemet stripping automated endothelial keratoplasty: a multicenter randomized controlled clinical trial. Ophthalmology 127(9): 1152-1159, 2020. PMID: 32386811. DOI: 10.1016/j.ophtha.2020.02.029
    OpenUrlCrossRefPubMed
    1. Machalińska A,
    2. Kuligowska A,
    3. Kowalska B and
    4. Safranow K
    : Comparative analysis of corneal parameters in swept-source imaging between DMEK and UT-DSAEK eyes. J Clin Med 10(21): 5119, 2021. PMID: 34768639. DOI: 10.3390/jcm10215119
    OpenUrlCrossRefPubMed
  19. ↵
    1. Matsou A,
    2. Pujari R,
    3. Sarwar H,
    4. Rana M,
    5. Myerscough J,
    6. Thomson SM,
    7. Nandakumar G,
    8. Zhang J and
    9. Rajan MS
    : Microthin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a randomized clinical trial. Cornea 40(9): 1117-1125, 2021. PMID: 33156076. DOI: 10.1097/ICO.0000000000002601
    OpenUrlCrossRefPubMed
    1. Mencucci R,
    2. Favuzza E,
    3. Marziali E,
    4. Cennamo M,
    5. Mazzotta C,
    6. Lucenteforte E,
    7. Virgili G and
    8. Rizzo S
    : Ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a fellow-eye comparison. Eye Vis (Lond) 7: 25, 2020. PMID: 32391399. DOI: 10.1186/s40662-020-00191-6
    OpenUrlCrossRefPubMed
  21. ↵
    1. Romano V,
    2. Pagano L,
    3. Gadhvi KA,
    4. Coco G,
    5. Titley M,
    6. Fenech MT,
    7. Ferrari S,
    8. Levis HJ,
    9. Parekh M and
    10. Kaye S
    : Clinical outcomes of pre-loaded ultra-thin DSAEK and pre-loaded DMEK. BMJ Open Ophthalmol 5(1): e000546, 2020. PMID: 33094167. DOI: 10.1136/bmjophth-2020-000546
    OpenUrlAbstract/FREE Full Text
  22. ↵
    1. Duggan MJ,
    2. Rose-Nussbaumer J,
    3. Lin CC,
    4. Austin A,
    5. Labadzinzki PC and
    6. Chamberlain WD
    : Corneal higher-order aberrations in Descemet membrane endothelial keratoplasty versus ultrathin DSAEK in the Descemet endothelial thickness comparison trial: a randomized clinical trial. Ophthalmology 126(7): 946-957, 2019. PMID: 30776384. DOI: 10.1016/j.ophtha.2019.02.007
    OpenUrlCrossRefPubMed
  23. ↵
    1. Yamaguchi T,
    2. Satake Y,
    3. Dogru M,
    4. Ohnuma K,
    5. Negishi K and
    6. Shimazaki J
    : Visual function and higher-order aberrations in eyes after corneal transplantation: How to improve postoperative quality of vision. Cornea 34 Suppl 11: S128-S135, 2015. PMID: 26448170. DOI: 10.1097/ICO.0000000000000589
    OpenUrlCrossRefPubMed
  24. ↵
    1. Dickman MM,
    2. Cheng YY,
    3. Berendschot TT,
    4. van den Biggelaar FJ and
    5. Nuijts RM
    : Effects of graft thickness and asymmetry on visual gain and aberrations after descemet stripping automated endothelial keratoplasty. JAMA Ophthalmol 131(6): 737-744, 2013. PMID: 23579576. DOI: 10.1001/jamaophthalmol.2013.73
    OpenUrlCrossRefPubMed
  25. ↵
    1. Seery LS,
    2. Nau CB,
    3. McLaren JW,
    4. Baratz KH and
    5. Patel SV
    : Graft thickness, graft folds, and aberrations after descemet stripping endothelial keratoplasty for fuchs dystrophy. Am J Ophthalmol 152(6): 910-916, 2011. PMID: 21803326. DOI: 10.1016/j.ajo.2011.05.003
    OpenUrlCrossRefPubMed
  26. ↵
    1. Heinzelmann S,
    2. Böhringer D,
    3. Eberwein P,
    4. Reinhard T and
    5. Maier P
    : Outcomes of Descemet membrane endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty from a single centre study. Graefes Arch Clin Exp Ophthalmol 254(3): 515-522, 2016. PMID: 26743748. DOI: 10.1007/s00417-015-3248-z
    OpenUrlCrossRefPubMed
  27. ↵
    1. Madi S,
    2. Leon P,
    3. Nahum Y,
    4. D’Angelo S,
    5. Giannaccare G,
    6. Beltz J and
    7. Busin M
    : Five-year outcomes of ultrathin Descemet stripping automated endothelial keratoplasty. Cornea 38(9): 1192-1197, 2019. PMID: 31246680. DOI: 10.1097/ICO.0000000000001999
    OpenUrlCrossRefPubMed
  28. ↵
    1. Phillips PM,
    2. Phillips LJ,
    3. Muthappan V,
    4. Maloney CM and
    5. Carver CN
    : Experienced DSAEK surgeon’s transition to DMEK: Outcomes comparing the last 100 DSAEK surgeries with the first 100 DMEK surgeries exclusively using previously published techniques. Cornea 36(3): 275-279, 2017. PMID: 27918355. DOI: 10.1097/ICO.0000000000001069
    OpenUrlCrossRefPubMed
  29. ↵
    1. Tourtas T,
    2. Laaser K,
    3. Bachmann BO,
    4. Cursiefen C and
    5. Kruse FE
    : Descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 153(6): 1082-90.e2, 2012. PMID: 22397955. DOI: 10.1016/j.ajo.2011.12.012
    OpenUrlCrossRefPubMed
  30. ↵
    1. Maier AB,
    2. Milek J,
    3. Joussen AM,
    4. Dietrich-Ntoukas T and
    5. Lichtner G
    : Systematic review and meta-analysis: Outcomes after Descemet membrane endothelial keratoplasty versus ultrathin Descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 245: 222-232, 2022. PMID: 36220351. DOI: 10.1016/j.ajo.2022.09.013
    OpenUrlCrossRefPubMed
  31. ↵
    1. Kurji KH,
    2. Cheung AY,
    3. Eslani M,
    4. Rolfes EJ,
    5. Chachare DY,
    6. Auteri NJ,
    7. Nordlund ML and
    8. Holland EJ
    : Comparison of visual acuity outcomes between nanothin Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty. Cornea 37(10): 1226-1231, 2018. PMID: 30028748. DOI: 10.1097/ICO.0000000000001697
    OpenUrlCrossRefPubMed
  32. ↵
    1. Cheung AY,
    2. Hou JH,
    3. Bedard P,
    4. Grimes V,
    5. Buckman N,
    6. Eslani M and
    7. Holland EJ
    : Technique for preparing ultrathin and nanothin Descemet stripping automated endothelial keratoplasty tissue. Cornea 37(5): 661-666, 2018. PMID: 29329121. DOI: 10.1097/ICO.0000000000001510
    OpenUrlCrossRefPubMed
  33. ↵
    1. Tourabaly M,
    2. Chetrit Y,
    3. Provost J,
    4. Georgeon C,
    5. Kallel S,
    6. Temstet C,
    7. Bouheraoua N and
    8. Borderie V
    : Influence of graft thickness and regularity on vision recovery after endothelial keratoplasty. Br J Ophthalmol 104(9): 1317-1323, 2020. PMID: 31848210. DOI: 10.1136/bjophthalmol-2019-315180
    OpenUrlAbstract/FREE Full Text
  34. ↵
    1. Terry MA
    : Endothelial keratoplasty: why aren’t we all doing Descemet membrane endothelial keratoplasty? Cornea 31(5): 469-471, 2012. PMID: 22367047. DOI: 10.1097/ICO.0b013e31823f8ee2
    OpenUrlCrossRefPubMed
    1. Green M and
    2. Wilkins MR
    : Comparison of early surgical experience and visual outcomes of DSAEK and DMEK. Cornea 34(11): 1341-1344, 2015. PMID: 26356748. DOI: 10.1097/ICO.0000000000000590
    OpenUrlCrossRefPubMed
  36. ↵
    1. Hamzaoglu EC,
    2. Straiko MD,
    3. Mayko ZM,
    4. Sáles CS and
    5. Terry MA
    : The first 100 eyes of standardized Descemet stripping automated endothelial keratoplasty versus standardized Descemet membrane endothelial keratoplasty. Ophthalmology 122(11): 2193-2199, 2015. PMID: 26271841. DOI: 10.1016/j.ophtha.2015.07.003
    OpenUrlCrossRefPubMed
  37. ↵
    1. Busin M and
    2. Albé E
    : Does thickness matter: ultrathin Descemet stripping automated endothelial keratoplasty. Curr Opin Ophthalmol 25(4): 312-318, 2014. PMID: 24865169. DOI: 10.1097/ICU.0000000000000071
    OpenUrlCrossRefPubMed
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Ultrathin-Descemet Stripping Automated Endothelial Keratoplasty Versus Descemet Membrane Endothelial Keratoplasty: A Systematic Review and Meta-analysis
GEORGIOS S. DIMTSAS, MARILITA M. MOSCHOS
In Vivo Jan 2023, 37 (1) 400-409; DOI: 10.21873/invivo.13092
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