Descemet Membrane Endothelial Keratoplasty versus Descemet Stripping Automated Keratoplasty – Outcome of One Single Surgeon’s More Than 200 Initial Consecutive Cases

PURPOSE: To compare clinical outcome and complications of Descemet stripping automated keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK). METHODS: This is a retrospective study of the first consecutive cases of DSAEK and DMEK performed by a single surgeon at a tertiary referral centre. Best-corrected visual acuity (BCVA), postoperative complications, rate of rebubbling and regraft were the main outcome measures. RESULTS: The study included 241 eyes, 116 subjected to DSAEK and 125 to DMEK. Fuchs endothelial dystrophy (FED) was the predominant diagnosis in both groups. Mean BCVA at all follow-ups up to 2 years was in favour of DMEK. Median BCVA (decimal) at 1 year was 0.4 (0.13–0.60; interquartile range) for the DSAEK and 0.8 (0.6–1.0) for the DMEK group, p<0.001. Preoperative BCVA in the DSAEK group was lower than in DMEK. There was no significant difference in visual improvement between groups at 1 year postoperatively. The most common postoperative complication in both groups was a pupillary block with high intraocular pressure, 27% and 34% respectively. This was not affected by the presence of an iridectomy/iridotomy. In the DMEK group, gas provided significantly better adherence than air (p=0.020). Rebubbling for partial/total detachment was performed in 7% (DSAEK) and 11% (DMEK) of cases, p=0.361. Regraft within 2 years was performed in 13% of eyes in the DSAEK and 17% in the DMEK group, p=0.450. No case of graft rejection occurred. CONCLUSION: Both DSAEK and DMEK provide overall satisfying outcome and the two techniques do not differ significantly in postoperative pupillary block, detachment rate, early graft failure or graft rejection. However, differences at baseline may have influenced or obscured potential differences. In DMEK procedures, gas seems to facilitate early graft adherence.