Contralateral eye comparison of descemet membrane endothelial keratoplasty and descemet stripping automated endothelial keratoplasty

Am J Ophthalmol. 2015 Jan;159(1):155-9.e1. doi: 10.1016/j.ajo.2014.10.009. Epub 2014 Oct 14.


Purpose: To compare objective and subjective outcomes after Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in the fellow eye of the same patients.

Study design: Single-center, retrospective case series.

Methods: Seventeen patients with bilateral Fuchs endothelial dystrophy who underwent DSAEK earlier in 1 eye, and later underwent DMEK in the contralateral eye, composed study population. A chart review was completed to obtain follow-up data for at least 6 months after each surgery. Outcome measures included best spectacle-corrected visual acuity (BSCVA) and endothelial cell density (ECD). Subjective questionnaires were used to assess patients' satisfaction.

Results: Preoperative BSCVA (logMAR) was similar in both groups, 0.66 ± 0.4 in DMEK and 0.59 ± 0.4 in DSAEK (P = .6). The DMEK group showed better BSCVA than the DSAEK group at the 6-month time point (0.25 ± 0.1 and 0.39 ± 0.1, for DMEK and DSAEK, respectively, P = .02). Preoperative ECD (cells/mm(2)) was similar in both groups (2647 ± 249 and 2768 ± 404, P = .3) in DMEK and DSAEK, respectively. There was statistically significant difference found in ECD at 6 months (2227 ± 565 for DMEK and 1780 ± 433 for DSAEK, P = .049). Subjective level of average satisfaction after DMEK was 6 and after DSAEK was 4.87 ± 1.19 (P = .002).

Conclusions: DMEK provided better visual outcome and lower endothelial cell loss than DSAEK and a higher level of patient satisfaction when assessed at 6 months after surgery. Our results comparing the 2 procedures in the same patients support the benefits of DMEK, and suggest the need for long-term studies observing this new surgical procedure.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cell Count
  • Descemet Stripping Endothelial Keratoplasty / methods*
  • Endothelium, Corneal / pathology
  • Female
  • Fuchs' Endothelial Dystrophy / physiopathology
  • Fuchs' Endothelial Dystrophy / surgery*
  • Humans
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Retrospective Studies
  • Visual Acuity / physiology