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    Is DSAEK still the gold standard over DMEK for endothelial disease?

    Visual acuity outcomes after 3 years, simplicity of procedure among advantages

     

    Endothelial keratoplasty (EK) procedures now comprise more than half the cornea transplant surgeries performed, and Descemet’s stripping automated endothelial keratoplasty (DSAEK) is still the overwhelming majority of those procedures, said Terry Kim, MD, professor of ophthalmology, Duke University Eye Center, Durham, NC.

     

    DSAEK outcomes

    Dr. Kim proposed several reasons why DSAEK is—and should remain—the preferred EK technique, even as Descemet membrane endothelial keratoplasty (DMEK) is gaining acceptance.

    According to the Eye Bank Association of America, in 2015 there were 22,514 DSEK/DSAEK procedures performed (of the total 27,208 overall EK procedures; the remainder were DMEK).

    Endothelial cell loss is important to consider, but literature from Drs. Marianne and Francis Price, Jr.’s group shows comparable cell loss mean rates between DSAEK (38%) and DMEK (36%) at 1 year post-surgery,1-3 Dr. Kim said.

    “We certainly have heard about the superior visual acuity outcomes we get with the DMEK procedure,” Dr. Kim acknowledged, but two studies from Devers Eye Institute4, 5 found the 6-month best spectacle corrected visual acuity after DMEK was > 20/20 in 46% of patients, and 94% achieved > 20/40.

     

    “They also found 3 years after DSAEK, 47.2% achieved > 20/20 and 98% achieved > 20/40,” he said. “We’re seeing gradual VA improvement with DSAEK.”

    He suggested asking patients if they are “20/happy.” The overwhelming majority of his patients are extremely happy with their DSAEK outcomes, he said.

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