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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

     

    Comorbidities

    DSAEK “certainly has an advantage for patients with comorbidities and complex cases,” Dr. Kim said, particularly in aphakic patients, or in those with corneal scarring, corneal haze, or anterior basement membrane dystrophy.

    “Those scenarios can limit your visualization of the tissue unfolding and its manipulation, which can have more of an adverse impact in DMEK compared with DSAEK,” he said.

    Patients with deep or unstable anterior chambers, with a previous history of a trabeculectomy, tube-shunt, or pars plana vitrectomy; those with anterior chamber IOLs or unstable posterior chamber IOLs; and those with floppy iris syndrome or intracorneal synechiae also fare better with DSAEK, he said.

    Dr. Kim and his team published their successful experience using DSAEK with a donor injector system, which had a very short learning curve, and a very predictable and reproducible result, they said.6

    In their series, there was a very low rate of postoperative complications, no cases of iatrogenic primary graft failure or dislocated grafts, and a graft survival rate of 100% during the relatively short follow-up period,  the retrospective study stated.

    Any EK case—DSAEK, DMEK—is associated with postoperative complications, including partial and full detachments.

    “But DSAEK does not require an emergent treatment to address the complication,” Dr. Kim said. “There have been reports of spontaneous reattachment in both partial and full DSAEK detachments, and there is an option of rebubbling and centering that graft, which can be performed at the slit lamp or in a minor operating room.”

    In short, he said, DSAEK provides a lower graft rejection rate compared with penetrating keratoplasty, easier and more reproducible techniques and outcomes than DMEK, and eventually comparable visual outcomes with DMEK.

     

    Terry Kim, MD

    P: 919/681-3568

    E: [email protected]

    This article was adapted from Dr. Kim’s presentation during Cornea Subspecialty Day at the 2016 meeting of the American Academy of Ophthalmology. Dr. Kim has no relevant financial interests to disclose.

     

    References

    1. Gorovoy IR, Gorovoy MS. Descemet membrane endothelial keratoplasty postoperative year 1 endothelial cell counts. Am J Ophthalmol. 2015;159:597-600 e2.

    2. Price MO, Gorovoy M, Benetz BA, et al. Descemet’s stripping automated endothelial keratoplasty outcomes compared with penetrating keratoplasty from the Cornea Donor Study. Ophthalmology. 2010;117:438-444.

    3. Guerra FP, Anshu A, Price MO, Price FW. Endothelial keratoplasty: fellow eyes comparison of Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty. Cornea. 2011;3012:1382-1386.

    4. Hamzaoglu EC, Straiko MD, Mayko ZM, et al. The First 100 Eyes of Standardized Descemet Stripping Automated Endothelial Keratoplasty versus Standardized Descemet Membrane Endothelial Keratoplasty. Ophthalmology. 2015;122:2193-2199.

    5. Li JY, Terry MA, Goshe J, et al. Three-year visual acuity outcomes after Descemet’s stripping automated endothelial keratoplasty. Ophthalmology. 2012;1196:1126-129.

    6. Khor WB, Kim T. Descemet-stripping automated endothelial keratoplasty with a donor tissue injector. J Cataract Refract Surg. 2014;4011:1768-1772.

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