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Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty

Published:March 07, 2012DOI:https://doi.org/10.1016/j.ajo.2011.12.012

      Purpose

      To evaluate visual outcome and endothelial cell survival after Descemet membrane endothelial keratoplasty (DMEK) in comparison with Descemet stripping automated endothelial keratoplasty (DSAEK).

      Design

      Single-center, retrospective, consecutive case series.

      Methods

      Thirty-eight eyes of 38 consecutive patients undergoing DMEK, who completed a 6-month follow-up, were compared with 35 eyes of 35 consecutive patients undergoing DSAEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. Main outcome measures included best-corrected visual acuity (in logarithm of the minimal angle of resolution [logMAR] units) and endothelial cell density within a 6-month follow-up.

      Results

      Best-corrected visual acuity increased from 0.70 ± 0.48 logMAR and 0.75 ± 0.32 logMAR before surgery to 0.21 ± 0.14 logMAR and 0.48 ± 0.19 logMAR 3 months after DMEK and DSAEK (P < .001), respectively, and to 0.17 ± 0.12 logMAR and 0.36 ± 0.15 logMAR 6 months after DMEK and DSAEK (P < .001), respectively. Endothelial cell density decreased from 2575 ± 260 cells/mm2 and 2502 ± 220 cells/mm2 before surgery to 1498 ± 244 cells/mm2 and 1778 ± 420 cells/mm2 3 months after DMEK and DSAEK (P < .001), respectively, and to 1520 ± 299 cells/mm2 and 1532 ± 495 cells/mm2 6 months after DMEK and DSAEK (P = .483), respectively. Central corneal thickness decreased from 652 ± 92 μm before surgery to 517 ± 45 μm 6 months after DMEK, and from 698 ± 137 μm before surgery to 618 ± 66 μm 6 months after DSAEK.

      Conclusions

      DMEK provided faster and more complete visual rehabilitation when compared with DSAEK. However, there were no significant differences concerning endothelial cell survival within a 6-month follow-up.
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      Biography

      Theofilos Tourtas, MD, graduated from Medical School of the Aristotle University of Thessaloniki, Greece, in 2007. He is a staff member of the Department of Ophthalmology at the Erlangen University Medical School, Germany since 2008. His research interests include corneal diseases and glaucoma.

      Biography

      Friedrich E. Kruse, MD, is Professor and Chairman, Department of Ophthalmology, Erlangen University Medical School, Germany since 2004. After graduation from Heidelberg Medical School in 1984, he worked at the Bascom Palmer Eye Institute, Miami, Florida from 1988 to 1991. His research interests include cellular and molecular biology of the ocular surface corneal transplantation and laser application.