Elsevier

Ophthalmology

Volume 122, Issue 11, November 2015, Pages 2193-2199
Ophthalmology

Original article
The First 100 Eyes of Standardized Descemet Stripping Automated Endothelial Keratoplasty versus Standardized Descemet Membrane Endothelial Keratoplasty

Presented at: American Academy of Ophthalmology Cornea Society Fall Educational Symposium, October 2014, Chicago, Illinois.
https://doi.org/10.1016/j.ophtha.2015.07.003Get rights and content

Purpose

To compare results of the first 100 eyes of Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) that were performed with a standardized technique at a single institution.

Design

Single-center, retrospective case series.

Participants

The first 100 eyes of standardized DSAEK and DMEK that underwent surgery for Fuchs corneal dystrophy at our center. We excluded patients with prior ocular surgery other than cataract surgery to limit confounding variables.

Methods

Best spectacle-corrected visual acuity (BSCVA; in logarithm of the minimal angle of resolution [logMAR] units) was obtained and specular microscopy of donor corneal tissue was performed before surgery. Postoperative complications, BSCVA, and the percent of endothelial cell loss (ECL) recorded at 6 months were compared with the Student t test. Patients with pre-existing ocular comorbidity that impacted visual potential such as macular degeneration, amblyopia, advanced glaucoma, and other optic neuropathies were excluded from the analysis of visual acuity, but were included for the outcomes of complications and ECL.

Main Outcome Measures

Visual acuity improvement, ECL 6 months after surgery, postoperative complications, iatrogenic primary graft failure (IPGF), and rebubbling.

Results

Of the 200 eyes, 62 DSAEK eyes and 70 DMEK eyes had 6-month BSCVA available and no vision-limiting comorbidities. Mean BSCVA increased from 0.41±0.19 logMAR and 0.27±0.11 logMAR before surgery to 0.20±0.13 logMAR and 0.11±0.13 logMAR 6 months after DSAEK and DMEK, respectively (P < 0.001). Seventy-one DSAEK eyes and 70 DMEK eyes had 6-month ECL data available: ECL was 25.9±14.0% after DSAEK and 27.9±16.0% after DMEK (P = 0.38). There were no IPGFs in the DSAEK cohort and there were 4 of 100 IPGFs after DMEK (P = 0.12). Rebubbling was performed in 2 of 100 eyes after DSAEK and in 6 of 100 eyes after DMEK (P = 0.28).

Conclusions

Compared with DSAEK, DMEK provided better visual recovery and comparable 6-month ECL. The DMEK group had a higher, although not statistically significant, percentage of rebubbling procedures and IPGFs.

Section snippets

Methods

This study was a retrospective review of prospectively collected data from our ongoing institutional review board-approved study of EK at the Devers Eye Institute, Portland, Oregon. All study procedures adhered to the tenets of the Declaration of Helsinki.

After establishing the definition of a standardized technique for each procedure, we identified the records of the first 100 eyes undergoing DSAEK and the first 100 eyes undergoing DMEK performed with that standardized technique. We excluded

Standard Descemet Stripping Automated Endothelial Keratoplasty Technique

The standardized technique as described previously by our group was used for all DSAEK surgeries.6, 10 In all cases, precut tissue prepared with a Moria microkeratome (Artificial Anterior Chamber [AAC]; Moria Systems, Doylestown, PA) by an eye bank technician was used. In brief, all surgeries were completed through a temporal 5-mm scleral tunnel incision. An appropriately sized circular template mark is applied to the corneal surface to delineate the stripping area. Descemet membrane is

Demographics

Mean patient ages were 68.1±11.0 years and 70.6±9.6 years for the DSAEK and DMEK groups, respectively (P = 0.10). The mean ages of donors were 58.3±11.4 years and 65.9±6.2 years for the DSAEK and DMEK groups, respectively (P < 0.001). Transplantation with concurrent cataract surgery (triple procedure) was performed in 73 eyes (73%) in the DSAEK group and 52 eyes (52%) in the DMEK group (P = 0.003). The remaining eyes were pseudophakic at the time of their initial evaluation (Table 1). No

Discussion

Compared with DSAEK, DMEK has several accepted advantages. Descemet membrane endothelial keratoplasty offers rapid visual rehabilitation, minimal astigmatic and hyperopic shift, lower higher-order aberrations, and a lower rejection rate.8, 13, 14, 15, 16, 17, 18, 19, 20 An additional advantage of DMEK over DSAEK is that there is no need for expensive and specialized equipment such as a microkeratome or femtosecond laser for preparation of the donor tissue.18

Although the functional results of

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    Financial Disclosure(s): The author(s) have made the following disclosure(s): M.A.T.: Royalties - Storz (Bausch & Lomb)

    Author Contributions:

    Conception and design: Hamzaoglu, Straiko, Mayko, Terry

    Analysis and interpretation: Hamzaoglu, Straiko, Mayko, Sáles, Terry

    Data collection: Hamzaoglu, Straiko, Mayko, Sáles, Terry

    Obtained funding: none

    Overall responsibility: Hamzaoglu, Straiko, Mayko, Sáles, Terry

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