Contralateral Eye Comparison of Descemet Membrane Endothelial Keratoplasty and Descemet Stripping Automated Endothelial Keratoplasty

Purpose To compare objective and subjective outcomes after Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in the fellow eye of the same patients. Study Design Single-center, retrospective case series. Methods Seventeen patients with bilateral Fuchs endothelial dystrophy who underwent DSAEK earlier in 1 eye, and later underwent DMEK in the contralateral eye, composed study population. A chart review was completed to obtain follow-up data for at least 6 months after each surgery. Outcome measures included best spectacle-corrected visual acuity (BSCVA) and endothelial cell density (ECD). Subjective questionnaires were used to assess patients' satisfaction. Results Preoperative BSCVA (logMAR) was similar in both groups, 0.66 ± 0.4 in DMEK and 0.59 ± 0.4 in DSAEK ( P = .6). The DMEK group showed better BSCVA than the DSAEK group at the 6-month time point (0.25 ± 0.1 and 0.39 ± 0.1, for DMEK and DSAEK, respectively, P = .02). Preoperative ECD (cells/mm2 ) was similar in both groups (2647 ± 249 and 2768 ± 404, P = .3) in DMEK and DSAEK, respectively. There was statistically significant difference found in ECD at 6 months (2227 ± 565 for DMEK and 1780 ± 433 for DSAEK, P = .049). Subjective level of average satisfaction after DMEK was 6 and after DSAEK was 4.87 ± 1.19 ( P = .002). Conclusions DMEK provided better visual outcome and lower endothelial cell loss than DSAEK and a higher level of patient satisfaction when assessed at 6 months after surgery. Our results comparing the 2 procedures in the same patients support the benefits of DMEK, and suggest the need for long-term studies observing this new surgical procedure.