Comparison and Correlation of the Donor-Recipient Interface Changes and Visual Outcomes Between nDSEK and DSEK

Purpose: This study aimed to compare the donor-recipient interface changes between non-Descemet stripping endothelial keratoplasty (nDSEK) and Descemet stripping endothelial keratoplasty (DSEK) and assess their correlation with the postoperative best spectacle-corrected visual acuity (BCVA). Methods: This retrospective study collected clinical data on patients with corneal endothelial decompensation who underwent either nDSEK or DSEK between August 2019 and April 2023. The donor-recipient interface particle density, interface haze, visual outcome, and graft dislocation were compared between nDSEK and DSEK groups. Results: A total of 66 eyes from 66 patients (nDSEK n: 31 eyes and DSEK n: 35 eyes) were included. At 12 months postoperatively, nDSEK had a mean interface particle density of 631.97 ± 143.95 particles/mm², significantly higher than DSEK's 518.20 ± 121.72 particles/mm² (p=0.001). The interface haze was also greater in nDSEK (78.16 ± 13.74) compared with DSEK (64.21 ± 14.78) (p < 0.001). BCVA improved similarly in both groups, with nDSEK changing from 1.92 ± 0.26 to 0.37 ± 0.11 and DSEK from 1.85 ± 0.24 to 0.34 ± 0.10 (p=0.149). Correlation analysis revealed a significant association between interface particle density and interface haze in both the nDSEK (correlation coefficient: 0.716, p < 0.001) and DSEK (correlation coefficient: 0.618, p < 0.001) groups. However, there was no significant correlation between interface particle density and postoperative BCVA for either the nDSEK (correlation coefficient: -0.028, p=0.883) or DSEK (correlation coefficient: 0.111, p=0.525) group. Similarly, no significant correlation was found between interface haze and postoperative BCVA in both groups (nDSEK: correlation coefficient: -0.080, p=0.670 and DSEK: correlation coefficient: -0.210, p=0.227). Graft dislocation rates were comparable: 3.2% in nDSEK and 2.9% in DSEK (p=0.931). Conclusion: nDSEK exhibited more interface particles and haze than standard DSEK, but visual outcomes and graft attachment were similarly effective.