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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

     

    Donor tissue

    At Duke University, “we have the luxury and ability to use pre-cut donor tissue,” Dr. Kim said, but acknowledged there are some issues to consider when choosing a technique.

    “There are less restrictions on donor age criteria for a DSAEK procedure, whereas we have to use a little older tissue for the DMEK procedure,” he said. “With DSAEK, we have known tissue quality.”

    Variables such as graft thickness and bed diameters are uniform with DSAEK tissue, and the literature is filled with studies noting a known 1.0 to 1.5 D hyperopic shift after DSAEK.

    “Many of us are now using thinner DSAEK graft tissue, 50 to 80 μm, and some have reported very good VA outcomes with ultra-thin DSAEK procedures.”

     

    Other advantages

    Dr. Kim cited simplicity among other advantages for using a DSAEK procedure over other techniques.

    “Pre-cut tissue is very straightforward to fold, insert, and unfold,” he said. “We have the ability to center the graft with a 25-gauge needle or a flap roller, which you cannot do with DMEK.”

    Further, DSAEK does not require peeling Descemet’s membrane off “which carries a risk of damaging or tearing the graft.” DSAEK does not require an injector/inserter, peripheral iridotomy, or SF6 gas preparation.

    DSAEK also allows surgeons to choose from a number of donor insertion techniques, and is generally more predictable and reproducible.
    “And because we’re not tapping on the cornea all day like we do with DMEK, there’s less iatrogenic epithelial trauma,” Dr. Kim said.

    Comorbidities

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