Endothelial Cell Loss Curve in Descemet Stripping Automated Endothelial Keratoplasty versus Descemet Membrane Endothelial Keratoplasty

• Autor(a) principal: Vilares-Morgado, Rodrigo
• Data de Publicação: 2022
• Outros Autores: Barbosa, Ana Luísa, Moleiro, Ana Filipa, Torrão, Luís, Neves-Cardoso, Pedro, Moreira, Raúl, Falcão-Reis, Fernando, Pinheiro-Costa, João
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://doi.org/10.48560/rspo.25960
• topic: Artigos Originais

INTRODUCTION: Our purpose was to compare best corrected visual acuity (BCVA), endothelial cell density (ECD) and postoperative complications in adult patients with corneal endothelial disorders who were submitted to descemet stripping automated endothelial keratoplasty (DSAEK) or descemet membrane endothelial keratoplasty (DMEK). METHODS: Retrospective, single-centre, observational cohort study. Fifty one eyes from 51 patients with corneal endothelial disorders who were submitted to either a traditional DSAEK (n=23 patients) or a DMEK (n=28 patients) at Centro Hospitalar Universitário S. João (Porto, Portugal), and followed for at least one year after the procedure in our department were included. Patients without at least one ECD determination after transplantation and those who experienced primary graft failure were excluded. Patient demographics, BCVA with the logMAR scale before and one year after grafting, indication for transplantation, and postoperative complications were recorded. Specular microscopy with ECD determination (in cells/mm2) was performed on all donor corneas before grafting and regularly after transplantation, as part of our patient’s usual follow-up. RESULTS: Patients’ demographics, indications for transplantation and BCVA before graft- ing were similar in both groups. BCVA 1-year after transplantation was better in the DMEK group (0.26 ± 0.19 vs 0.47 ± 0.29 in the DSAEK group; p=0.003). ECD in donor corneas before grafting was similar in both groups (p=0.986). Graft ECD after transplantation was higher in the DMEK group at up to 5 months (p<0.001), 5 to 9 months (p=0.037) and 9 to 15 months follow-up (p=0.003), being similar in posterior determinations. 2 DMEK eyes required rebubblin. Two DSAEK eyes suffered graft rejection. CONCLUSION: In our cohort, DMEK presented better visual outcomes than DSAEK. The DMEK group showed higher mean ECD and lower ECD loss in the first 15 months of follow-up, but posterior measurements were similar in both groups. Therefore, both techniques had similar long-term mean ECD and ECD loss and other criteria should be used to determine which one is best suited for each case in our clinical practice.