Is ultra-thin Descemet stripping automated endothelial keratoplasty a viable alternative to Descemet membrane endothelial keratoplasty? A systematic review and meta-analysis

Tanu Singh; Parul Ichhpujani; Rohan Bir Singh; Sudesh Arya; Suresh Kumar

doi:10.1177/25158414221147823

Is ultra-thin Descemet stripping automated endothelial keratoplasty a viable alternative to Descemet membrane endothelial keratoplasty? A systematic review and meta-analysis

Ther Adv Ophthalmol. 2023 Feb 7:15:25158414221147823. doi: 10.1177/25158414221147823. eCollection 2023 Jan-Dec.

Authors

Tanu Singh¹, Parul Ichhpujani², Rohan Bir Singh^{3

4

5}, Sudesh Arya², Suresh Kumar²

Affiliations

¹ Assistant Professor, Department of Ophthalmology, Government Medical College and Hospital, Sector-32, Chandigarh 160030, India.
² Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India.
³ Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
⁴ Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.
⁵ Discipline of Ophthalmology and Visual Sciences, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.

Abstract

Background: Ultra-thin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) is a recently developed surgical procedure that has shown promising results for the management of various corneal endothelial diseases.

Objectives: To evaluate the outcomes of the UT-DSAEK to the Descemet membrane endothelial keratoplasty (DMEK).

Design: A systematic analysis of the studies comparing UT-DSAEK with DMEK by evaluating one or more outcomes (vision, complications, and post-operative endothelial cell counts) was performed. The meta-analysis was done if two or more studies reported a common outcome.

Methods: We used PubMed, EMBASE, and SCOPUS databases to identify articles comparing the outcomes of UT-DSAEK with DMEK and performed a meta-analysis using RevMan, version 5.4.

Results: A total of six studies were included in this review (two randomized clinical trials and four non-randomized comparative studies). Our analysis showed the patients who underwent DMEK cases showed better visual outcomes with a mean difference of 0.06 LogMAR (95% CI: 0.04-0.09) in BCVA, albeit with i ² of 52% (heterogenous values). The evidence was weak, with the most weightage on retrospective studies. UT-DSAEK showed significantly fewer complications such as graft dislocations, with an odds ratio of 0.25 (95% CI: 0.13-0.48). There was no significant difference in the endothelial cell counts with a mean difference of 86.34 (95%CI: -133.09 to -305.77).

Conclusion: Although the literature is limited on UT-DSAEK with post-operative visual acuity that could be practically at par with DMEK, lesser complication rates and comparable post-operative endothelial cells could be a suitable alternative to DMEK for corneal endothelial pathologies.

Keywords: DMEK; Descemet membrane endothelial keratoplasty; UT-DSAEK; endothelial keratoplasty; meta-analysis; ultra-thin Descemet stripping automated endothelial keratoplasty.