Visual Outcomes After Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty—Comparison of Specific Matched Pairs

Abstract

PURPOSE: To compare visual rehabilitation after Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) for Fuchs endothelial dystrophy. METHODS: The medical records of patients undergoing endothelial keratoplasty were retrospectively evaluated. A DMEK (n = 25 eyes) and a DSAEK (n = 25 eyes) group were formed. Specific matched pairs consisting of 1 DMEK and 1 DSAEK eye with the same preoperative best spectacle-corrected visual acuity (BSCVA) were built and compared with regard to visual rehabilitation, subjective refraction, central corneal thickness, and endothelial cell density. RESULTS: Preoperative median BSCVA (logarithm of the minimal angle of resolution) was for both groups 0.7 (range, 0.2-1.70). At 12 months, median BSCVA was 0.0 (range, -0.08 to 0.7) after DMEK and 0.3 (range, 0.1-0.52) after DSAEK (P < 0.001). The spherical equivalent changed after DMEK from 0.0 D (range, -2.75 to 4.63 D) to 0.5 D (range, -1 to 2.5 D) and after DSAEK from -0.32 D (range, -2.50 to 1 D) to 0.63 D (range, -2.38 to 2 D). Central corneal thickness decreased from 718 μm (range, 566-1041 μm) to 533 μm (range, 460-605 μm) after DMEK and from 650 μm (range, 527-749 μm) to 605 μm (range, 486-650 μm) after DSAEK. Endothelial cell density decreased from 2448 cells/mm (range, 2106-3000 cells/mm) to 1263 cells/mm (range, 589-2282 cells/mm) after DMEK and from 2348 cells/mm (range, 2156-2781 cells/mm) to 1327 cells/mm (range, 664-1972 cells/mm) after DSAEK. CONCLUSIONS: DMEK patients showed faster rehabilitation and higher BSCVA at all postoperative visits; however, the decline in graft's endothelial cell count and change in the spherical equivalent were similar for both procedures.