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DMEK vs DSAEK for Fuchs' endothelial dystrophy: a meta-analysis of comparative studies

Poster Details

First Author: R.Esteves Marques PORTUGAL

Co Author(s):    D. Cordeiro Sousa   A. Goncalves   A. Quintas   P. Guerra   W. Rodrigues        

Abstract Details

Purpose:

Fuchs Endothelial Dystrophy (FED) is a disabling corneal pathology, sometimes leading to significant visual impairment and impacting quality of life. Treatment options for advanced disease include endothelial keratoplasty procedures - Descemet Membrane Endothelial Keratoplasty (DMEK) and Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). We aimed to compare safety and efficacy profiles of DMEK vs. DSAEK in patients with FED.

Setting:

Ophthalmology Dept., Hospital de Santa Maria, Lisbon, Portugal.

Methods:

Electronic database search on MEDLINE and CENTRAL from inception to February 2017. We included all comparative studies of DMEK vs. DSAEK in patients with diagnosed FED. Studies assessing rescue procedures were excluded to minimize bias. We selected studies, extracted data and evaluated risk of bias. Primary efficacy outcome was mean difference (MD) in between preoperative best-corrected visual acuity (BCVA) and at 3, 6 and 12 months postoperatively. Secondary outcomes: rates of graft failure, rejection, and rebbubling; MD in endothelial cell density (ECD); and patient satisfaction.

Results:

Ten retrospective studies classified as of moderate methodological quality were included (n = 947 eyes, of them 646 DMEK). BCVA was better with DMEK at all evaluated timepoints (0.16 logMAR at 12 months) comparing to DSAEK (0.30 logMAR) (p<0.01). Patients were more satisfied after DMEK, preferring this technique (OR 10.29, 95% confidence interval (CI), 3.55-29.80, p<0.01). DMEK had a 60% lower rate of rejection (RR 0.4, 95% CI, 0.24- 0.67], p<0.01), requiring, however, more rebubblings (RR 2.10, 95% CI, 1.09-4.04, p=0.03). DMEK had more primary graft failures and less ECD loss, but statistical difference was not reached.

Conclusions:

This meta-analysis favours DMEK technique, which showed better post-operative results regarding BCVA, patient satisfaction and graft-related issues. However, the small number of studies and methodological issues prompt us to interpret these results carefully. To date, no prospective trials are available, and 5 trials are registered in ClinicalTrials.gov, none concluded. These studies will help us draw more definitive conclusions.

Financial Disclosure:

NONE

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