Systematic Review and Meta-analysis: Outcomes After Descemet Membrane Endothelial Keratoplasty Versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty
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INTRODUCTION
Diseases of the corneal endothelium, especially Fuchs endothel dystrophy (FED) and bullous keratopathy (BK), affect people all over the world and often cause visual problems up to vision loss and/or pain. The main surgical interventions for these diseases are the posterior lamellar surgical techniques, Descemet stripping (automated) endothelial keratoplasty (DS(A)EK), and Descemet membrane endothelial keratoplasty (DMEK). In contrast to the DS(A)EK technique—where the diseased endothelium and
SELECTION CRITERIA
This study included any study: (i) comparing DMEK and UT-DS(A)EK in patients with FED and BK, with respect to best corrected visual acuity (BCVA in logMAR), endothelial cell density (ECD), and postoperative complications, especially graft detachment with the need of re-bubbling, graft rejection, graft failure, and postoperative intraocular pressure (IOP) elevation; (ii) with a minimum follow-up time after intervention of 6 months; and (iii) with the study protocol and outcome of the
SEARCH RESULTS
The literature search identified a total of 163 potentially eligible publications (Figure 1). Of these, 11 met the inclusion criteria after screening of title and abstracts, and were subjected to a full-text review. The following four studies were excluded after quality assessment:28, 29, 30, 31 the study by Machalinska and associates reported statistically significant baseline differences between the two treatment groups, which affected the interpretability of the postoperative visual acuity.28
DISCUSSION
In this comprehensive, systematic review comparing the postoperative results between UT-DS(A)EK and DMEK, evidence was provided that DMEK provides superior postoperative BCVA than UT-DS(A)EK. Except for a higher re-bubbling rate after DMEK, the postoperative risks between both procedures did not differ.
Although several studies have shown that a thinner graft can improve BCVA after DS(A)EK and that UT-DS(A)EK results in a better postoperative visual acuity than conventional DS(A)EK,20, 21, 22, 23
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