Comparison of Early Surgical Experience and Visual Outcomes of DSAEK and DMEK

Purpose: To compare the outcomes of 2 different endothelial keratoplasty (EK) techniques [Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK)] sequentially learned by a corneal fellow. Methods: This is a retrospective comparative audit of all patients undergoing EK by 1 surgeon (M.G.) during fellowship. Surgical and functional success of both procedures were compared. Surgical success was evaluated by comparing short-term complications, and functional success by comparing visual outcomes in patients with Fuchs endothelial dystrophy (FED). Results: Twenty-six patients were included in the review (DSAEK 12 and DMEK 14). Phacoemulsification was combined with EK in 14 patients (DSAEK 6 and DMEK 8). The average follow-up duration was 3.5 months. Partial detachment requiring rebubbling was slightly more common in the DMEK group (DSAEK 1 and DMEK 5); total detachment requiring repositioning was less in the DMEK group (DSAEK 2 and DMEK 1). Only 1 patient experienced primary graft failure due to complicated graft insertion, and this patient underwent DMEK. Functional analysis included 14 patients with FED (DSAEK 7 patients, preoperative 6/18, postoperative 6/12; DMEK 7 patients, preoperative 6/12, postoperative 6/6). Average visual improvement was greater in the DMEK group (3.3 lines) than in the DSAEK group (1.3 lines; P = 0.047). In DMEK patients, the average postoperative endothelial cell count was 1612 cells per square centimeter. Conclusions: Contrary to common expectation, there were similar rates of surgical success while learning DMEK and DSAEK. Visual improvement in patients with FED undergoing DMEK was significantly better at this early point of comparison.