Preliminary results of a multicenter randomized clinical trial comparing Descemet Membrane Endothelial Keratoplasty (DMEK) with ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK)

Mor M. Dickman, Suryan Dunker, Robert Wisse, Robert J. Wijdh, Siamak Nobacht, Marjolijn C. Bartels, Mei L. Tang, Frank J. H. M. van den Biggelaar, Tos T.J.M. Berendschot, Rudy M.M.A. Nuijts

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Abstract

Purpose : To compare best corrected visual acuity, endothelial cell density, and complications after Descemet Membrane Endothelial Keratoplasty (DMEK) and ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK). Methods : Multicenter prospective randomized clinical trial (RCT). 55 eyes of 55 patients suffering from irreversible corneal endothelial dysfunction due to Fuchs' endothelial corneal dystrophy were randozmized to receive DMEK or UT-DSAEK in six tertiary and secondary eye clinics in the Netherlands. Donor grafts were centrally prepared by the Beverwijk Euro Cornea bank. Patients underwent ophthalmic examinations preoperatively and 3 months postoperatively. Results : Preoperative BCVA did not differ between both groups (DMEK:0.38±0.18 logMAR vs. UT-DSAEK:0.33±0.21 logMAR, P=0.32). Three months after the operation, BCVA improved significantly (P<0.001). However, there was no statistically significant difference in BCVA between both groups (DMEK: 0.16±0.16 vs. UT-DSAEK: 0.19±0.11 logMAR, P=0.59). One graft in each group was damaged during preparation. Donor endothelial cell density (ECD) did not differ between both groups (DMEK:2668±168 vs. UT-DSAEK:2638±193 cells/mm^2). Three months after the operation, ECD was significantly higher after DMEK (1868±478 vs. 1295±673 cells/mm^2, P= 0.01). Rebubbling was required in 17% of cases after DMEK, and was not reuquired after UT-DSAEK. Primary graft failure requiring repeated transplantation occurred in 7% of cases after DMEK, but not after UT-DSAEK. Conclusions : The preliminary results of this multicenter RCT indicate that DMEK and UT-DSAEK achieve a similar improvement in BCVA three months after the operation. However, DMEK was associated with a significantly higher complication rate. To the best of our knowlegde, this is the first report from a RCT comparing both transplantation techniques. This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Original languageEnglish
Article number1576
JournalInvestigative Ophthalmology and Visual Science
Volume59
Issue number9
Publication statusPublished - Jul 2018

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