Scheimpflug Densitometry After DMEK Versus DSAEK-Two-Year Outcomes

Area of Science:

• Ophthalmology
• Corneal Surgery
• Vision Science

Background:

• Endothelial keratoplasty techniques like DMEK and DSAEK aim to restore vision by replacing diseased corneal endothelium.
• Corneal densitometry (CD) is a measure of light scattering within the cornea, reflecting tissue opacity.
• Understanding postoperative corneal healing and visual outcomes is crucial for patient care.

Purpose of the Study:

• To compare the progression of corneal densitometry (CD) using Scheimpflug imaging after Descemet membrane endothelial keratoplasty (DMEK) versus Descemet stripping automated endothelial keratoplasty (DSAEK).
• To evaluate visual acuity and endothelial cell density following these two surgical procedures.

Main Methods:

• A comparative study included 54 DMEK and 25 DSAEK cases, with 20 pseudophakic eyes as controls.
• Scheimpflug corneal densitometry, best-corrected visual acuity (BCVA), endothelial cell density, and central corneal thickness were measured preoperatively and up to 24 months postoperatively.

Main Results:

• Both DMEK and DSAEK significantly reduced corneal opacity, with DMEK showing lower CD at 3 and 6 months postoperatively.
• While CD levels became comparable between DMEK and DSAEK by 12-24 months, best-corrected visual acuity (BCVA) remained significantly better after DMEK throughout the study.
• No significant difference in endothelial cell density was observed between the two surgical groups.

Conclusions:

• DMEK demonstrates superior early postoperative outcomes in terms of corneal transparency and visual acuity compared to DSAEK.
• Although corneal opacity normalizes similarly in the midterm, DMEK consistently offers better visual function.
• These findings suggest DMEK may be preferable for achieving optimal visual rehabilitation after endothelial keratoplasty.