Ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK) vs Descemet's membrane endothelial keratoplasty (DMEK): preliminary results of a multicenter prospective randomised controlled clinical trial

Session Details

Session Title: Surgical Cornea: Keratoplasty & Corneal Grafts

Session Date/Time: Sunday 23/09/2018 | 14:00-16:00

Paper Time: 15:00

Venue: Room A3, Podium 3

First Author: : S.Dunker THE NETHERLANDS

Co Author(s): :    M. Dickman   F. van den Biggelaar   R. Wisse   S. Nobacht   D. research   R. Nuijts     

Abstract Details

Purpose:

To compare the effectiveness and complication profile of UT-DSAEK (graft thickness aimed at ≤140µm) and DMEK.

Setting:

The study was carried out in four tertiary, and two secondary hospitals in the The Netherlands. Precut UT-DSAEK and pre-stripped DMEK grafts were prepared by a single eye bank.

Methods:

Fifty-four patients were randomly assigned to either UT-DSAEK or DMEK. Inclusion criteria were Fuchs’ endothelial dystrophy requiring primary corneal transplantation without vision limiting comorbidities in the study eye. Patients were randomized based on corrected distance visual acuity (CDVA), recipient central corneal thickness, age, gender, and recruitment center. CDVA was measured using standardized ETDRS charts and converted to logMAR. Endothelial cell density (ECD) was measured by specular microscopy.

Results:

Preoperative CDVA measured 0.38±0.18 logMAR in the DMEK group and 0.31±0.13 logMAR in the UT-DSAEK group. Three months postoperatively, CDVA was similar after DMEK (0.15±0.19 logMAR) and UT-DSAEK (0.22±0.13 logMAR; P=0.15). Donor ECD measured 2681±157 in the DMEK group and 2635±157 in the UT-DSAEK group. Three months postoperatively ECD was higher in the DMEK group (1895±488 vs. 1541±734;P=0.04). The hyperopic shift did not differ significantly between both groups (0.37±1.26, DMEK, vs. 0.66±0.95, UT-DSAEK;P=0.37). Rebubbling and repeated transplantation were more frequently after DMEK (7/29 versus 1/25 and 2/29 versus 0/25, respectively).

Conclusions:

The preliminary outcomes of this RCT indicate UT-DSAEK and DMEK result in similar improvements in CDVA three months after surgery. ECD loss was higher after UT-DSAEK, while rebubbling and repeated transplantation were more common after DMEK.

Financial Disclosure:

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