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Jesper Hjortdal, Uwe Pleyer, Conor C Murphy, Derek Tole, Bertrand Vabres; Comparison of DMEK and DSAEK in high and low risk posterior lamellar keratoplasty.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1299. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Corneal transplantation is overall a successful procedure, but graft failure due to immunological reactions is common. The current presentation focus on a comparison of the rate of immune reactions, cause and rate of failure, and visual acuity in DMEK and DSAEK surgeries for treatment of endothelial failure.
Patients were recruited at five European clinical sites af part of the VISICORT study (see Table 1). 183 eyes in 183 patients with endothelial failure were enrolled in this prospective, non-randomised study. Patients were included in a Low-risk group (LR) if they had Fuchs endothelial dystrophy and freedom from known risks factors for failure. Patients included in the High-risk group (HR) were those undergoing re-transplantation for a previous failed graft and/or had a diagnosis of pseudophakic bullous keratopathy or presented one or more risk factors.
Currently, 162 patients have completed their 6-month review, 156 their 1 year, and 84 their 2 –year review. Significantly (p<0.01) more patient in the DMEK group (23 of 101) underwent additional air-injection compared with the DSAEK group (7 of 82), but there was no difference between eyes in the LR and HR groups (p>0.05). Primary and later failures were similar after DMEK and DSAEK (p>0.05). Less (9 of 128) eyes in the LR group experienced a rejection episode than in the HR group (15 of 55 eyes) (P<0.01), but with no difference between the DMEK and DSAEK groups (p>0.05). At all post-operative points of follow-up, visual acuity was better (p<0.05) in the DMEK compared with the DSAEK group, but after 2 years visual acuity was similar (0.74±0.25 (decimal units) in the DMEK group and 0.67±0.27 in the DSAEK group). Endothelial cell density was significantly higher in the DMEK group compared with the DSAEK group at all follow-ups (p<0.05).
Re-bubbling procedures are more common after DMEK compared with DSAEK, but rejection episodes occur at a similar rates. The study indicates that visual acuity after DSAEK improve over time and reaches an almost similar functional outcome in patients treated by DMEK. Follow-up of patients is continuing and around 50,000 bio-samples have been collected and stored in a biobank for immunological profiling and will be accessible to other researchers involved in corneal transplantation.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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