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Theofilos Tourtas, Bjoern O. Bachmann, Kathrin Laaser, Claus Cursiefen, Friedrich E. Kruse; Descemet Membrane Endothelial Keratoplasty (DMEK) Outcomes Compared With Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Invest. Ophthalmol. Vis. Sci. 2012;53(14):3137.
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Up to now there is debate whether or not graft thickness determines functional outcome in posterior lamellar surgery. In order to answer this question functional outcome and endothelial cell survival were compared between patients undergoing Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK).
Single-center, retrospective, consecutive case series of 38 consecutive patients undergoing DMEK and 35 consecutive patients undergoing DSAEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. Main outcome measures included best-corrected visual acuity (in logarithm of the minimal angle of resolution [logMAR] units) and endothelial cell density within a 6-month follow-up.
Three months after DMEK, 83% of eyes reached a visual acuity of 20/40 or better, which increased to 95% 6 months after surgery. 36% of eyes reached a visual acuity of 20/25 or better 3 months after surgery, which increased to 50% 6 months after surgery. Three months after DSAEK, 28% of eyes reached a visual acuity of 20/40 or better, which increased to 43% 6 months after surgery. No patient reached a visual acuity of 20/25 or better 3 months after surgery. 6% of eyes reached a visual acuity of 20/25 or better 6 months after surgery. Endothelial cell density decreased from 2575 ± 260 cells/mm² and 2502 ± 220 cells/mm² before surgery to 1498 ± 244 cells/mm² and 1778 ± 420 cells/mm² 3 months after DMEK and DSAEK (P<.001), respectively, and to 1520 ± 299 cells/mm² and 1532 ± 495 cells/mm² 6 months after DMEK and DSAEK (P=0.483), respectively.
DMEK provided faster and more complete visual rehabilitation 6 months after surgery when compared with DSAEK. Endothelial cell survival was not significantly different between both groups, within a 6-month follow-up.
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