The First 100 Eyes of Standardized Descemet Stripping Automated Endothelial Keratoplasty versus Standardized Descemet Membrane Endothelial Keratoplasty

Ophthalmology. 2015 Nov;122(11):2193-9. doi: 10.1016/j.ophtha.2015.07.003. Epub 2015 Aug 11.


Purpose: To compare results of the first 100 eyes of Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) that were performed with a standardized technique at a single institution.

Design: Single-center, retrospective case series.

Participants: The first 100 eyes of standardized DSAEK and DMEK that underwent surgery for Fuchs corneal dystrophy at our center. We excluded patients with prior ocular surgery other than cataract surgery to limit confounding variables.

Methods: Best spectacle-corrected visual acuity (BSCVA; in logarithm of the minimal angle of resolution [logMAR] units) was obtained and specular microscopy of donor corneal tissue was performed before surgery. Postoperative complications, BSCVA, and the percent of endothelial cell loss (ECL) recorded at 6 months were compared with the Student t test. Patients with pre-existing ocular comorbidity that impacted visual potential such as macular degeneration, amblyopia, advanced glaucoma, and other optic neuropathies were excluded from the analysis of visual acuity, but were included for the outcomes of complications and ECL.

Main outcome measures: Visual acuity improvement, ECL 6 months after surgery, postoperative complications, iatrogenic primary graft failure (IPGF), and rebubbling.

Results: Of the 200 eyes, 62 DSAEK eyes and 70 DMEK eyes had 6-month BSCVA available and no vision-limiting comorbidities. Mean BSCVA increased from 0.41±0.19 logMAR and 0.27±0.11 logMAR before surgery to 0.20±0.13 logMAR and 0.11±0.13 logMAR 6 months after DSAEK and DMEK, respectively (P<0.001). Seventy-one DSAEK eyes and 70 DMEK eyes had 6-month ECL data available: ECL was 25.9±14.0% after DSAEK and 27.9±16.0% after DMEK (P=0.38). There were no IPGFs in the DSAEK cohort and there were 4 of 100 IPGFs after DMEK (P=0.12). Rebubbling was performed in 2 of 100 eyes after DSAEK and in 6 of 100 eyes after DMEK (P=0.28).

Conclusions: Compared with DSAEK, DMEK provided better visual recovery and comparable 6-month ECL. The DMEK group had a higher, although not statistically significant, percentage of rebubbling procedures and IPGFs.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cataract Extraction
  • Corneal Endothelial Cell Loss / pathology
  • Descemet Membrane*
  • Descemet Stripping Endothelial Keratoplasty / methods*
  • Descemet Stripping Endothelial Keratoplasty / standards
  • Endothelium, Corneal / transplantation*
  • Female
  • Fuchs' Endothelial Dystrophy / physiopathology
  • Fuchs' Endothelial Dystrophy / surgery*
  • Graft Survival / physiology
  • Humans
  • Lens Implantation, Intraocular
  • Male
  • Middle Aged
  • Postoperative Complications
  • Retrospective Studies
  • Tissue Donors
  • Visual Acuity / physiology