AI Article Synopsis
- The study compares DSAEK and DMEK outcomes performed by a skilled surgeon, focusing on patients with Fuchs corneal dystrophy.
- This retrospective analysis involved 200 eyes across 132 patients and tracked postoperative complications and visual acuity, revealing that while DMEK offered better vision at six months, it also showed higher endothelial cell loss and complications like posterior synechiae.
- Overall, transitioning from DSAEK to DMEK can lead to excellent visual outcomes with minimal complications, emphasizing the importance of following standardized surgical techniques.
Article Abstract
Purpose: To compare outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) when an experienced DSAEK surgeon transitions to DMEK while following 2 published endothelial keratoplasty surgical techniques.
Methods: This is a retrospective review of 200 eyes of 132 patients with Fuchs corneal dystrophy that underwent endothelial keratoplasty performed by one surgeon. Published, standardized techniques were followed for both DSAEK and DMEK. Postoperative complications were recorded. Best spectacle-corrected visual acuity (BSCVA), intraocular pressure, and central endothelial cell loss (ECL) were evaluated at 6 months postoperatively.
Results: There were no intraoperative complications. One DSAEK and 5 DMEK grafts developed graft detachment requiring rebubbling (P = 0.097). No iatrogenic primary graft failures occurred in the DSAEK group compared with one in the DMEK group. No pupil block episodes occurred in the DSAEK group compared with one in the DMEK group. Posterior synechiae formation occurred 15 times in the DMEK group and did not occur in the DSAEK group (P < 0.001). At 6 months, BSCVA was better in the DMEK group than in the DSAEK group (20/24; logMAR = 0.0844-20/32; logMAR = 0.2063) (P < 0.001). More eyes reached 20/20 or better BSCVA in the DMEK group compared with DSAEK (54.5%-13%) (P < 0.011). At 6 months, ECL was higher in the DMEK group than in the DSAEK group (31.9%-19.9%) (P < 0.001).
Conclusions: Complications can be minimized and excellent outcomes can be achieved, without a steep learning curve, when an experienced DSAEK surgeon transitions to DMEK following a standardized technique. Six-month vision outcomes are better in the DMEK group; however, the rate of a newly described complication, posterior synechiae formation, and 6-month ECL are higher in the DMEK group than in the DSAEK group.
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| http://dx.doi.org/10.1097/ICO.0000000000001069 | DOI Listing |
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- The findings showed that surgeon experience significantly impacted transplant success rates and complications, highlighting the importance of training and support systems to improve surgical outcomes over time.*
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