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    Ultra-thin DSAEK delivers better results than standard DSAEK

    Multicenter randomized study finds strong visual results to support its use

     

    Patients included were 18 years or older and had endothelial dysfunction. Patients were excluded if they had prior corneal transplantation, ocular comorbidity other than cataract, human leukocyte antigen typed transplantation, or were unable to communicate.

    Patient and donor demographics were similar between both study groups, Dr. Dickman said.

    Mean posterior lamellar thickness measured 209 µm in the standard group and 101 µm in the ultrathin group. Dr. Dickman and fellow researchers found a highly significant difference in visual acuity between the two groups, with a 1 ETDRS line advantage in favor of the ultra-thin group. At 3 months, the ultrathin group had an average BCVA of 0.17 logMAR compared with 0.28 logMAR in the standard DSAEK group. At 6 months, average BCVA was 0.14 logMAR in the ultrathin group compared with 0.24 logMAR in the standard group.

    Patients in both groups had a significant hyperopic shift, suggesting hyperopic shift is linked to factors other than central graft thickness, Dr. Dickman reported.

    Endothelial cell loss also was comparable between both groups, measuring ~40% after 3 months and stabilizing thereafter. Regarding complications, donor dislocation requiring air reinjection measured 15% in both groups. There was one primary graft failure in the ultrathin group that required a re-transplant. No graft rejection occurred during the follow up period.

    “The preliminary results show that ultra-thin DSAEK provides faster and better visual recovery, with similar hyperopic shift, endothelial cell density and complication profile compared to standard DSAEK,” Dr. Dickman said.

    Endothelial keratoplasties are now common in the U.S., Dr. Dickman said, citing statistics from the Eye Bank Association of America that showed 23,465 DSAEKs and 1,522 Descemet's membrane endothelial keratoplasties were performed in the U.S. in 2013.

    “The last decade has seen a revolution in corneal transplantation with endothelial keratoplasty replacing full-thickness grafts as the most common corneal transplantation surgery,” he said.

     

    Mor M. Dickman, MD

    E: mor.dickman@mumc.nl ; rudy.nuijts@mumc.nl

    This article was adapted from Dr. Dickman’s presentation during the World Cornea Congress meeting held in San Diego earlier this year. The presentation was entitled “Preliminary results of a multicenter prospective randomized controlled trial comparing ultra-thin and standard DSAEK.”

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