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DMEK versus DSAEK for Fuchs' endothelial dystrophy: A meta-analysis
Raquel Esteves Marques1,2, Paulo Silva Guerra1,2, David Cordeiro Sousa1,2,3
11 Departamento de Oftalmologia, Hospital de Santa Maria, Lisboa, Portugal.
European Journal of Ophthalmology
|April 18, 2018
Summary
Descemet membrane endothelial keratoplasty (DMEK) offers better visual acuity and patient satisfaction compared to Descemet stripping automated endothelial keratoplasty (DSAEK) for Fuchs' dystrophy. DMEK has lower rejection rates but requires more rebubbling procedures.
Area of Science:
- Ophthalmology
- Transplantation Surgery
Background:
- Fuchs' endothelial dystrophy is a progressive condition affecting the cornea's inner layer.
- Endothelial keratoplasty techniques like DMEK and DSAEK are used to restore vision by replacing damaged corneal endothelium.
Purpose of the Study:
- To compare the safety and efficacy of Descemet membrane endothelial keratoplasty (DMEK) versus Descemet stripping automated endothelial keratoplasty (DSAEK).
- To evaluate outcomes in adult patients diagnosed with Fuchs' endothelial dystrophy.
Main Methods:
- A systematic review and meta-analysis of 10 retrospective comparative studies.
- Included studies compared DMEK and DSAEK in Fuchs' endothelial dystrophy patients.
- Primary outcome was best-corrected visual acuity (BCVA) at 3, 6, and 12 months; secondary outcomes included graft failure, rejection, and patient satisfaction.
Main Results:
- DMEK demonstrated significantly better BCVA at 12 months (0.16 logMAR) compared to DSAEK (0.30 logMAR).
- DMEK showed a 60% lower rate of graft rejection but a higher rate of rebubbling.
- Patient satisfaction was substantially higher with DMEK.
Conclusions:
- DMEK appears to offer superior visual outcomes and patient satisfaction over DSAEK for Fuchs' endothelial dystrophy.
- Despite promising results, the findings should be interpreted cautiously due to study limitations, including short follow-up periods.