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Descemet's membrane endothelial keratoplasty vs microthin Descemet's membrane stripping automated endothelial keratoplasty: a randomised controlled trial

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First Author: R.Pujari UK

Co Author(s):    A. Matsou   H. Sarwar   M. Rana   S. Mysercough   J. Myerscough   M. Rajan     

Abstract Details

Purpose:

Best practice standards for corneal endothelial decompensation is evolving rapidly with the advent of Descemet Membrane Endothelial Keratoplasty (DMEK) and Ultrathin or Microthin Descemet Membrane Stripping Automated Endothelial Keratoplasty (UT-DSAEK or MT-DSAEK) with limited evidence so far comparing the two surgical techniques. We undertook a double blind randomised controlled trial to compare DMEK and MT-DSAEK in relation to visual outcome and complication rates.

Setting:

Opthalmology Department, Addenbrookes Hospital, Cambridge Biomedical Campus, Hill's Road, Cambridge, CB2 0QQ

Methods:

56 patients were randomised either to DMEK or the MT-DSAEK (28 eyes in each arm). Inclusion criteria included eyes with endothelial decompensation affecting vision but with no other ocular comorbidities influencing visual potential. Patients randomised to each arm were matched for age, pre-operative Best Spectacle Corrected Visual Acuity (BSCVA). The primary outcome measure was BSCVA at 3, 6 and 12 months. Secondary outcome measures included keratometry, complication rates, endothelial cell density and visual related Quality of Life (QoL) with regression analysis and t-tests utilised for statistical evaluation.

Results:

The DMEK group had consistently better visual acuity than MT-DSAEK group. DMEK eyes had significantly improved logMAR BSCVA of 0.15±0.11, 0.10±0.14 and 0.04±0.13 at 3, 6 and 12 months respectively compared to 0.22±0.12, 0.17±0.09 and 0.11±0.09 in MT-DSAEK. The graft detachment and primary failure rate was 0 % and 3.57 % in DMEK respectively compared to 3.57 % and 0 % in the MT-DSAEK group. Endothelial loss was similar between the groups. The mean Vision related QoL scores for the DMEK group was 92.0±8.6 at 12 months compared to 92.5±8.7 in MT-DSAEK.

Conclusions:

DMEK showed superior visual outcomes at 3, 6 and 12 months post-operatively compared to MT-DSAEK with no demonstrable difference in post-operative complications. Patient reported outcomes, however, showed similar satisfaction rates between the groups. Our study renders clear support for adoption of DMEK over MT-DSAEK in eyes with simple endothelial decompensation with no other ocular comorbidity. A similar study would be required to substantiate the best preference between the two procedures in complicated eyes with endothelial decompensation.

Financial Disclosure:

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