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Peng Yan, Salina Teja, Kashif Baig; Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) vs Ultra-Thin DSAEK (UT-DSAEK) vs Descemet’s Membrane Endothelial Keratoplasty (DMEK). Invest. Ophthalmol. Vis. Sci. 2013;54(15):1749.
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To compare the surgical and visual outcomes between DSAEK, UT-DSAEK and DMEK as treatments for Fuch’s Endothelial Dystrophy (FED) and Pseudophakic Bullous Keratopathy (PBK).
The first ten consecutive DSAEK, UT-DSAEK, and DMEK patients with either FED or PBK were reviewed retrospectively. In DSAEK, a 350um head was used for all single-pass dissections. In UT-DSAEK, donor corneas were prepared by a two-pass microkeratome dissection. In DMEK, a trephine-peel technique was used to prepare the graft. Data was collected from baseline up to 6-months follow-up, and outcomes including intraoperative and postoperative complications, visual rehabilitation, endothelial cell density and follow-up graft thickness were compared.
The average age was 76, 69, and 67.5 years for DSAEK, UT-DSAEK, and DMEK respectively. All patients had previous cataract extraction and intraocular lens placement, with an equal number of FED and PBK presentations. Mean donor endothelial cell count was 2597 for DSAEK, 2590 for UT-DSAEK group and 2709 for DMEK. No donor tissues were lost during tissue preparation. The DSAEK group had a mean preoperative best-corrected visual acuity (BCVA) of 20/200 with mean intraocular pressure (IOP) of 17mmHg. The UT-DSAEK group had a mean preoperative BCVA of 20/80 with mean IOP of 13mmHg. The DMEK group had a mean pre-operative BCVA of 20/120 with mean preoperative IOP of 14mmHg. One patient in the DMEK group had a large persistent peripheral graft detachment despite 3 re-bubbling attempts and required a second DMEK procedure. Six-month outcomes of visual rehabilitation, endothelial cell loss, graft thickness and graft rejection for all patients will be available by March 2013.
Endothelial Keratoplasty is constantly evolving, with DSAEK currently being the standard of care. Available literature has shown the benefits of UT-DSAEK and DMEK, including lower rates of graft rejection, faster and greater visual recovery and comparable endothelial cell loss. The difficulties with tissue preparation however, have resulted in a slower transition to these two procedures. This comparison of outcomes between our first 10 consecutive patients having each procedure will shed light on the relative learning curve and encourage corneal surgeons to consider the benefits of providing these advanced treatments to their patients.
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