ULTRATHIN DESCEMET STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY (UT-DSAEK) VERSUS DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY (DMEK) - A SYSTEMATIC REVIEW & META-ANALYSIS

The aim of this systematic review and meta-analysis was to evaluate the differences in visual acuity outcomes, endothelial cell count, central corneal thickness and complications between two forms of endothelial keratoplasty, Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) and Descemet Membrane Endothelial Keratoplasty (DMEK).

Endothelial Keratoplasty (EK) is a commonly performed transplant procedure used in the treatment of corneal endothelial dysfunction. Within the scope of EK, there has been a shift towards the use of thinner grafts. Ultrathin-DSAEK (UT-DSAEK) is a relatively new form of EK that aims to bridge the gap between conventional DSAEK’s less challenging use and DMEK’s superior results.

A comprehensive search on Medline, Embase and Cochrane Library databases was conducted to identify studies reporting comparative results of UT-DSAEK versus DMEK. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for search strategy. Of 135 titles, 7 studies met the inclusion criteria; best corrected visual acuity (BCVA) (LogMAR), endothelial cell density (ECD) (cells/mm²), central corneal thickness (CCT) (μm) and complications were compared, with all statistical analysis performed using Review Manager, version 5.3. P < 0.05 was considered statistically significant.

A total of 306 patients were identified. DMEK resulted in significantly better BCVA at 3 months (0.13 vs 0.23, p = 0.003) and 1 year post-op (0.10 vs 0.19, p = 0.0005). UT-DSAEK resulted in significantly lower total complications (25.2% vs 57.3%, p = 0.0001) and rates of re-bubbling (11.0% vs 33.7%, p = 0.004), in addition to significantly higher CCT (592.0 vs 524.8, p < 0.00001). No differences were found in ECD between the two procedures (1,673.8 vs 1,705.3, p = 0.77).